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The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

HU Peng, LI Yu-wei, LI Yun-hui, LUO Bin, WEN Wen, YANG Bo. Department of Intervention Radiology, the Affiliated Hospital of Luzhou Medical College , Luzhou, Sichuan Province 646000, China  
Objective To analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results The causes of uterine bleeding after caesarean section included uterine artery pseudoaneurysm (n = 26), uterine atony (n = 18), placental factors (n = 11), gestational hypertension (n = 8), coexisting uterine fibroids (n = 1) and uterine bleeding of unknown reason (n = 1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (J Intervent Radiol, 2011, 20: 613-616)
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