Use of intra-arterial nitroglycerin during uterine artery embolization for severe postpartum hemorrhage with uterine artery vasospasm.

Abstract

OBJECTIVE:

Uterine artery embolization (UAE) is a standard method for treating postpartum hemorrhage (PPH), although uterine artery vasospasm during UAE may lead to failure of hemostasis. Here, we report our experience with a case of PPH in which the bleeding was successfully controlled by intra-arterial administration of nitroglycerin during the second UAE.

CASE REPORT:

A 30-year-old woman experienced PPH following a successful cesarean section, and a UAE was performed. However, 6 hours later, vaginal bleeding restarted; the reason for unsuccessful embolization during the first UAE was vasoconstriction due to hypovolemic shock. We performed a second UAE, but uterine bleeding continued. After intra-arterial administration of nitroglycerin, hemostasis was confirmed, and there was no reperfusion of the uterine artery. After these two UAE procedures, no recurrence of bleeding was observed.

CONCLUSION:

Thus, use of intra-arterial nitroglycerin was effective for controlling uterine artery vasospasm during UAE. However, larger studies are required to confirm these findings.

• Authors: Liangcheng Wang, Isao Horiuchi, Yukiko Mikami, Kenjiro Takagi, Tomohisa Okochi, Kohei Hamamoto, Emiko Chiba, Katsuhiko Matsuura
• Journal: Taiwanese journal of obstetrics & gynecology (Taiwan J Obstet Gynecol) Vol. 54 Issue 2 Pg. 187-90 (Apr 2015) ISSN: 1875-6263 [Electronic] China (Republic : 1949- )
• PMID: 25951726 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015. Published by Elsevier B.V.

Chemical References

• Vasodilator Agents
• Nitroglycerin

Topics

• Adult
• Cesarean Section
• Combined Modality Therapy
• Constriction, Pathologic
• Female
• Humans
• Nitroglycerin (therapeutic use)
• Postpartum Hemorrhage (physiopathology, therapy)
• Pregnancy
• Recurrence
• Uterine Artery (physiopathology)
• Uterine Artery Embolization
• Vasodilator Agents (therapeutic use)