Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography

被引:17
作者
Kawamura, Yosuke [1 ]
Kondoh, Eiji [1 ]
Hamanishi, Junzo [1 ]
Kawasaki, Kaoru [1 ]
Fujita, Kohei [1 ]
Ueda, Akihiko [1 ]
Kawamura, Akeo [1 ]
Mogami, Haruta [1 ]
Konishi, Ikuo [1 ]
机构
[1] Kyoto Univ, Dept Gynecol & Obstet, Kyoto 6068507, Japan
关键词
dynamic contrast-enhanced computed tomography; intrauterine balloon tamponade; post-partum hemorrhage; treatment decision-making; uterine atony; INTRAUTERINE BALLOON; HELICAL CT; ARTERIAL; EMBOLIZATION; ANGIOGRAPHY; MDCT;
D O I
10.1111/jog.12123
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
AimPost-partum hemorrhage (PPH) is the leading cause of maternal mortality. Identification of the precise bleeding site is generally important to control hemorrhage, but such an approach has not been fully established in the context of PPH. We postulated that visualization of bleeding sites could aid treatment decisions in the management of PPH. MethodsWe conducted a prospective review of 26 patients who underwent dynamic computed tomography (CT) for PPH. ResultsA total of 17 cases presented with uterine bleeding, eight with vaginal hematomas, and one with hemoperitoneum. Overall, dynamic CT identified contrast media extravasation in the arterial phase in 12 of 26 (46.2%) cases: the upper (n=4) and the lower uterine segment including the cervix (n=2), subfascial space (n=1) and vagina (n=5). Identification of precise arterial bleeding sites using CT provided informative guidance about where to place balloons for intractable uterine bleeding, and how to manage hemoperitoneum and vaginal hematomas. In addition, dynamic CT revealed the existence of a subtype of uterine atony, which is characterized by focal active arterial bleeding in the upper uterine segment. Furthermore, negative contrast extravasation extracted cases of PPH that were well controlled without the need for surgical or radiological intervention. No patient required emergency hysterectomy to control PPH. ConclusionDynamic CT has potential clinical utility in treatment decision-making for PPH.
引用
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页码:67 / 74
页数:8
相关论文
共 13 条
[11]  
Mohseni S, 2011, AM SURGEON, V77, P1176
[12]   Use of Multidetector Row CT to Evaluate the Need for Bronchial Arterial Embolization in Hemoptysis Patients [J].
Mori, Hidenori ;
Ohno, Yasushi ;
Tsuge, Yusuke ;
Kawasaki, Masanori ;
Ito, Fumitaka ;
Endo, Junki ;
Funaguchi, Norihiko ;
La, Bu Lin Bai ;
Kanematsu, Masayuki ;
Minatoguchi, Shinya .
RESPIRATION, 2010, 80 (01) :24-31
[13]   Relative threshold of detection of active arterial bleeding: In vitro comparison of MDCT and digital subtraction angiography [J].
Roy-Choudhury, Shuvro H. ;
Gallacher, David J. ;
Pilmer, John ;
Rankin, Sheila ;
Fowler, Geoff ;
Steers, Jeff ;
Dourado, Renato ;
Woodburn, Paul ;
Adam, Andreas .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2007, 189 (05) :W238-W246