Endovascular Strategy in Obstetrics

Abstract

Post-partum hemorrhage (PPH) requires medical resources to resuscitate hemorrhagic shock patients. The concept of damage control surgery in obstetrics has become widespread, and resuscitative endovascular balloon occlusion of the aorta (REBOA) can be a means of resuscitation in PPH. However, the potential benefits of endovascular strategies in obstetrics are not fully understood. This review aims to share the knowledge and experience of the endovascular strategy in the field of obstetrics among both interventional radiologists and obstetricians through the summary of the literature and multi-specialty expert consensus in the Japanese Society of Diagnostic Interventional Radiology in Emergency, Critical care and Trauma (DIRECT). The endovascular strategies include REBOA, arterial embolization, and common or internal iliac artery balloon occlusion (CIABO or IIABO). Uterine artery embolization achieves rapid definitive hemostasis while leaving fertility with a less invasive procedure. N-butyl-2-cyanoacrylate (NBCA) should be chosen as needed for coagulopathy. The obestetrics team (obstetricians and midwives) and the resuscitation team (doctors from emergency medicine, anesthesiology, interventional radiology, and nurses) would each have to develop a command system, and control and cooperate in parallel. The consensus for the timing of arterial access and the patient’s positioning for pelvic examination and femoral arterial access should be established in advance.