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

作者：Wang Liangcheng; Horiuchi Isao; Mikami Yukiko; Takagi Kenjiro^*; Okochi Tomohisa; Hamamoto Kohei; Chiba Emiko; Matsuura Katsuhiko

来源：Taiwanese Journal of Obstetrics & Gynecology, 2015, 54(2): 187-190.

DOI：10.1016/j.tjog.2014.05.006

• nitroglycerin
• postpartum hemorrhage
• uterine artery
• uterine artery embolization
• vasoconstriction

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.

• 出版日期2015-4