Today’s case 7 – Vaginal postpartum bleeding

Vaginal postpartum bleeding

This patient is a 32-year-old female who experienced fetal death in utero today.

She has a pre-existing coagulopathy, and due to the anticipated risk of massive bleeding during childbirth, embolization for postpartum bleeding has been pre-emptively requested.

Initial pelvic aortography obtained using 5Fr pigtail catheter.
Delayed angiography revealed active bleeding in uterus from utreine arteries.
(contralateral oblique image for Left internal iliac artery)
RAO 19”
postpartum bleeding
Catheter was changed to RUC catheter (Merit medical), left uterine artery was selected and selective angiography of left uterine artery was obtained.
Arrows : Vaginal branches from uterine artery.
Progreat 2.0 Microcatheter with Meister microguidewire were used to proceed to the distal branch of uterine artery
(Not to embolize vaginal branches from uterine artery ; which runs downward from uterine artery)
1000-1400 um and 1400-2000 um gelfoam were used to embolize uterine artery and its branches.
Right uterine artery was also embolized with gelfoam
Final angiography was taken using 5Fr pigtail catheter.
Pigtail catheter tip should be located nearby renal arteries.
Because gonadal arteries can be the culprit artery for postpartum bleeding and the arteries are usually arised from abdominal aorta just below the renal arteries.
Final angiography was taken using 5Fr pigtail catheter.
Pigtail catheter tip should be located nearby renal arteries.
Because gonadal arteries can be the culprit artery for postpartum bleeding and the arteries are usually arised from abdominal aorta just below the renal arteries.

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