Postpartum haemorrhage – online course
Authors: S. Protto and L. Ratnam
Reviewers: M. Deutschmann, T. Jahnke, A. Krajina, C. Nice and M. Tsitskari
This course corresponds to chapter 18.104.22.168.9 Arterial Problems in Obstetrics and Gynaecology in the European Curriculum and Syllabus for IR.
Postpartum haemorrhage (PPH) occurs in 6% of all deliveries, is responsible for 25% of maternal deaths worldwide, and is the leading cause of acute hysterectomy. PPH is defined by the World Health Organisation (WHO) as blood loss of > 500ml either in vaginal or caesarean delivery. The most common causes of PPH include uterine atony (80%), laceration of the genital tract, retention of placental fragments, coagulopathy and abnormal placentation. The incidence of abnormal placentation is increasing in frequency with a quoted mortality rate ranging from 7 – 10% worldwide. The most common form is placenta accreta (75-78%), followed by placenta increta (17%) and placenta percreta (5%). The diagnosis of abnormal placentation of all three types is usually made with ultrasound identification.
In cases of PPH, interventional radiologists should be part of the multidisciplinary team treating the patient. If conservative management steps are not successful, endovascular treatment should be attempted. In the majority of these cases, transarterial embolisation (TAE) by means of non-permanent embolic material is successful. In cases of abnormal placentation diagnosed in the antenatal period, the placement of prophylactic occlusion balloons in the uterine arteries, internal iliac arteries or even in the infrarenal aorta is increasingly used to manage these complex patients, with embolisation performed if required.
The results of these techniques are extremely good, with reported haemorrhage control of up to 100%. In general, failure of treatment is due to the presence of collateral vessels or vasoconstriction during the procedure. In these cases, however, a second embolisation should treat the bleeding. Moreover, no adverse effects on fertility have been reported.
TAE and prophylactic placement of occlusion balloons are safe and effective treatments in patients presenting respectively with PPH and abnormal placentation.
- Describe the vascular anatomy of the female pelvis
- Explain the difference between primary and secondary PPH, list the causes of PPH and the possible different treatments (i.e. in uterine atony vs abnormal placentation)
- Recognise the indications for uterine artery embolisation in PPH and abnormal placentation
- Recognise the appropriate embolic agent to utilise in PPH and the reason for use. Describe the principles of performing uterine artery embolisation for PPH and placement of prophylactic occlusion balloons
- Summarise the potential complications of TAE and occlusion balloons, and the management of these complications
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter 22.214.171.124.9 Arterial Problems in Obstetrics and Gynaecology.
The format of the course is easy to use and interactive by including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1 European CME credit (ECMEC).
Upon purchase, access to complete and revisit the course is granted for an enrolment period of 90 days. The certificate of completion will be available beyond the enrolment period in the new myCIRSE area.
Release date: January 2020
This course is available until January 3, 2022.