RESUMO
Postpartum haemorrhage (PPH) is a significant cause of maternal mortality globally, necessitating prompt and efficient management. This review provides a comprehensive exploration of endovascular treatment dimensions for both primary and secondary PPH, with a focus on uterine atony, trauma, placenta accreta spectrum (PAS), and retained products of conception (RPOC). Primary PPH, occurring within 24 h, often results from uterine atony in 70% of causes, but also from trauma, or PAS. Uterine atony involves inadequate myometrial contraction, addressed through uterine massage, oxytocin, and, if needed, mechanical modalities like balloon tamponade. Trauma-related PPH may stem from perineal injuries or pseudoaneurysm rupture, while PAS involves abnormal placental adherence. PAS demands early detection due to associated life-threatening bleeding during delivery. Secondary PPH, occurring within 24 h to 6 weeks postpartum, frequently arises from RPOC. Medical management may include uterine contraction drugs and hemostatic agents, but invasive procedures like dilation and curettage (D&C) or hysteroscopic resection may be required.Imaging assessments, particularly through ultrasound (US), play a crucial role in the diagnosis and treatment planning of postpartum haemorrhage (PPH), except for uterine atony, where imaging techniques prove to be of limited utility in its management. Computed tomography play an important role in evaluation of trauma related PPH cases and MRI is essential in diagnosing and treatment planning of PAS and RPOC.Uterine artery embolization (UAE) has become a standard intervention for refractory PPH, offering a rapid, effective, and safe alternative to surgery with a success rate exceeding 85% (Rand T. et al. CVIR Endovasc 3:1-12, 2020). The technical approach involves non-selective uterine artery embolization with resorbable gelatine sponge (GS) in semi-liquid or torpedo presentation as the most extended embolic or calibrated microspheres. Selective embolization is warranted in cases with identifiable bleeding points or RPOC with AVM-like angiographic patterns and liquid embolics could be a good option in this scenario. UAE in PAS requires a tailored approach, considering the degree of placental invasion. A thorough understanding of female pelvis vascular anatomy and collateral pathways is essential for accurate and safe UAE.In conclusion, integrating interventional radiology techniques into clinical guidelines for primary and secondary PPH management and co-working during labour is crucial.
RESUMO
La histeroscopia quirúrgica es un procedimiento mínimamente invasivo, aunque no exento de complicaciones potencialmente peligrosas. El medio de distensión más usado es la glicina porque es de baja viscosidad, bajo coste y transparencia, tiene compatibilidad con la electrocirugía. Sin embargo, el exceso de absorción de esta solución conlleva una serie de efectos adversos que van desde alteraciones hidroelectrolíticas leves hasta la hiponatremia severa, edema agudo de pulmón (EAP), coma, colapso cardiovascular y defunción. Presentamos un caso de EAP secundario a un exceso de absorción de glicina durante la realización de una miomectomía histeroscópica (AU)
Surgical hysteroscopy is a minimally invasive procedure that may result in potentially serious complications. The solution most commonly used for distension is glycine because of its low viscosity, low cost, transparency and compatibility with electrosurgery. However, excessive absorption of this fluid has adverse effects, ranging from mild fluid and electrolyte alterations to severe hyponatremia, acute pulmonary edema, coma, cardiovascular collapse and death. We report a case of acute pulmonary edema due to excessive absorption of glycine during hysteroscopic myomectomy (AU)
