SIR: Interventional radiology makes childbirth safer
Interventional radiology treatments are making childbirth safer for women who have C-sections that are complicated by massive bleeding and for those who suffer from the pregnancy condition of "invasive" placenta, according to two studies released at the annual meeting of the Society of Interventional Radiology (SIR) this week in San Diego.
"With embolization, interventional radiologists can block life-threatening bleeding immediately and effectively-from the inside out," said Michael S. Stecker, MD, interventional radiologist at Brigham and Women's Hospital in Boston. Interventional radiologists guide a catheter up a uterine artery using x-ray imaging. Once at the site of bleeding, clotting agents, such as tiny sponge-like gelfoam particles or little metal coils, are released to block an injured vessel and stop the bleeding.
"The women we treated tended to need fewer blood transfusions, had shorter hospital stays and did not have recurrence of the bleeding. All in all, our study shows that minimally invasive interventional radiology treatments can help control potentially life-threatening bleeding in women after C-sections with minimal complications," he added.
Similarly, interventional radiologists are making childbirth safer for women who suffer from a rare-but increasingly frequent-birth condition when a woman's placenta grows or "invades" into the uterine wall, according to the researchers.
"Minimally invasive interventional radiology treatments-that safely and immediately control bleeding and that may eliminate the need for a hysterectomy-are absolutely making childbirth safer for women," said John R. Kachura, MD, interventional radiologist at Mount Sinai Hospital in Toronto. "Before interventional radiology treatment was available, the placenta couldn't be delivered and women would have to have a hysterectomy or in some cases died," he added. Canadian interventional radiologists controlled excessive bleeding in women with a combination of balloon catheters inserted into uterine arteries pre-delivery and uterine artery embolization after delivery.
Typically, treatment options for this bleeding, or postpartum hemorrhage, included conservative management or taking the mother to surgery to find the bleeding vessel and stop the bleeding. In some cases, surgical control of bleeding might even require a hysterectomy. More recently, interventional radiologists have added to the treatment options by being able to find and stop the bleeding with embolization, said Stecker.
Over two and a half years, 13 women (ages 28 and older) who urgently needed embolization to control bleeding after a c-section were referred to the interventional radiology service at Brigham and Women's Hospital, the researchers said. Since bleeding complications after c-sections are uncommon, there was limited information as to the outcome of the different treatment methods.
In a retrospective study, the investigators analyzed trends or patterns in their hospital course and treatment outcomes, finding that this severe bleeding can happen either immediately after the c-section or up to several weeks after the delivery. A specific type of injury to the blood vessel known as a pseudoaneurysm-which is a contained blood vessel rupture-tends to show up later.
"Overall, regardless of any of the clinical circumstances, bleeding following C-section was stopped promptly and effectively with minimal complications by embolization procedures performed by interventional radiology," said Stecker. "Interventional radiology treatments avoid open surgery, general anesthesia, a long recovery time and other serious risk factors associated with surgical control of the bleeding. In preventing the need for hysterectomy, embolization may preserve a woman's uterus, allowing her to have other children."
Canadian researchers studied 14 women (ages 23 and older) over a six-year period, who were diagnosed with invasive placenta that was confirmed by a pre-delivery MRI. Interventional radiologists worked in a multidisciplinary team with obstetricians. The interventional radiologists guided balloon catheters into a woman's left and right uterine artery before delivery-to be ready to inflate (just like in angioplasty), if needed at delivery to block excessive blood flow, explained interventional radiologist J. Robert D. Beecroft, MD, who along with Kachura was a co-lead for the Mount Sinai study.
"Often with massive bleeding, there is so much blood coming at the obstetrician that it is impossible for him or her to see from the outside in order to surgically intervene. Since interventional radiologists visualize what they are doing from the inside of the vessel using imaging, we can see the blood supply, stop the bleeding and pinpoint the location for embolization treatment," Beecroft said.
After delivery, the researchers said that if an invasive placenta could not be delivered, the obstetrician left the placenta in place; interventional radiologists used uterine artery embolization-with absorbable gelatin sponge-to close blood vessels to the placenta, in essence, cutting off its blood supply so that it would die and eventually be reabsorbed by the body.
The retrospective study evaluated intraoperative blood loss, finding that obstetricians immediately see a dramatic decrease in bleeding once the balloons are inflated (allowing for easier surgical intervention). In examining hysterectomy rate, researchers found "considerable improvement," with 75 percent of the women keeping their uteri (compared to previous statistics showing that 80 percent of women had hysterectomies), said Beecroft. He explained that interventional radiologists worked collaboratively with obstetricians/maternal fetal medicine specialists at Mount Sinai to provide a multidisciplinary approach for patients.