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VOLUME 25 , ISSUE S3 ( December, 2021 ) > List of Articles


Interventional Radiology in Obstetric Emergencies

Suyash Kulkarni, Nitin S Shetty, Anurag Gupta, Saketh Rao, Harshit Bansal

Keywords : Interventional radiologist, Interventional radiology, Obstetric emergencies, Obstetric hemorrhage embolization, Postpartum hemorrhage, Prophylactic balloon catheter insertion, Uterine artery embolization

Citation Information :

DOI: 10.5005/jp-journals-10071-24090

License: CC BY-NC 4.0

Published Online: 12-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Postpartum hemorrhage (PPH) is one of the common causes of morbidity as well as mortality among pregnant women. Obstetric hemorrhage embolization (OHE)/uterine artery embolization (UAE) is the preferred treatment for PPH which has failed medical therapy. In cases of placental accreta spectrum (PAS), balloon catheter can be prophylactically placed in internal iliac arteries (IIAs) bilaterally before delivery to enable postpartum control of bleeding. An inferior vena cava (IVC) filter can be placed under fluoroscopy for a pregnant woman with deep vein thrombosis (DVT) for whom anticoagulation is contraindicated or needs to be stopped at the time of labor. Injection of chemical into the gestational sac can be performed under ultrasonography (USG) guidance to treat ectopic pregnancy. Percutaneous or transvaginal drainage of a collection can be done by ultrasound or computed tomography (CT) guidance for puerperal sepsis. Percutaneous nephrostomy (PCN) is performed for obstructive ureterolithiasis in case of urosepsis or significant stone burden. Sonography should be used for the guidance of interventional radiology (IR) procedures whenever possible. Fluoroscopy must be used only if necessary, giving special attention to radiation-sparing maneuvers.

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  1. Rand T, Patel R, Magerle W, Uberoi R. CIRSE standards of practice on gynaecological and obstetric haemorrhage. CVIR Endovasc 2020;3(1):85. DOI: 10.1186/s42155-020-00174-7.
  2. Iwata A, Murayama Y, Itakura A, Baba K, Seki H, Takeda S. Limitations of internal iliac artery ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases of placenta previa accreta. J Obstet Gynaecol Res 2010;36(2):254–259. DOI: 10.1111/j.1447-0756.2009.01157.x.
  3. Pelage JP, Soyer P, Repiquet D, Herbreteau D, Le Dref O, Houdart E, et al. Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology 1999;212(2):385–389. DOI: 10.1148/radiology.212.2.r99jl05385.
  4. Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol 2010;33(5):887–895. DOI: 10.1007/s00270-010-9864-4.
  5. Lim AK, Agarwal R, Seckl MJ, Newlands ES, Barrett NK, Mitchell AW. Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors. Radiology 2002;222(3):640–644. DOI: 10.1148/radiol.2223010035.
  6. Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, et al. Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. Cardiovasc Intervent Radiol 2015;38(5):1068–1081. DOI: 10.1007/s00270-015-1054-y.
  7. Lopera J, Suri R, Kroma GM, Garza-Berlanga A, Thomas J. Role of interventional procedures in obstetrics/gynecology. Radiol Clin 2013;51(6):1049–1066. DOI: 10.1016/j.rcl.2013.07.008.
  8. Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynecol Obstet 2018;140(3):291–298. DOI: 10.1002/ijgo.12410.
  9. Milford W, Chadha Y, Lust K. Use of a retrievable inferior vena cava filter in term pregnancy: case report and review of literature. Aust N Z J Obstet Gynaecol 2009;49(3):331–333. DOI: 10.1111/j. 1479-828X.2009.01004.x.
  10. Silver RM, Branch DW. Placenta accreta spectrum. New Engl J Med 2018;378(16):1529–1536. DOI: 10.1056/NEJMcp1709324.
  11. Thabet A, Kalva SP, Liu B, Mueller PR, Lee SI. Interventional radiology in pregnancy complications: indications, technique, and methods for minimizing radiation exposure. Radiographics 2012;32(1): 255–274. DOI: 10.1148/rg.321115064.
  12. Josephs SC. Obstetric and gynecologic emergencies: a review of indications and interventional techniques. Semin Intervent Radiol 2008;25(4):337–346. DOI: 10.1055/s-0028-1102992.
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