PREVENTIVE EMBOLIZATION OF UTERINE ARTERIES AS A METHOD OF CONTROLLING MASSIVE OBSTETRIC HEMORRHAGES

Аннотация

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Aim. To assess the sphere of application, safety and efficacy of preventive embolization of uterine arteries (EMA) before obstetric interventions with a high risk of developing massive bleeding. Material and Methods. Analysis of domestic and foreign scientific articles of recent years from the bases of Pubmed and eLibrary. Results and Discussion. Uterine arteries embolization (UAE) in modern obstetrical practice is a common procedure which is successfully implied for surgical treatment of uterine myomas and postpartum hemorrhages. However, it is more rational to use this method in preventive purposes to avoid massive blood loss. Prophylactic UAE may be conducted during the procedure of interrupting ectopic pregnancy (cervical pregnancy or in rumen after caesarean section), as well as before removal of vascularized placenta remnants and delivery by caesarean section in case of true placenta ingrowth (placenta accreta), which helps to avoid such serious complications, as a hysterectomy. UAE is performed by catheterization of the right common femoral artery or bilateral catheterization according to recommendations. In the uterine arteries, an embolization drug is administered (usually polyvinyl alcohol). Thrombin may also be used as an embolization agent, which has a high affinity to the tissues of the body and biodegradability. Conclusions. It is recommended for women with high hemorrhage risk or bleeding symptoms to perform an UAE before obstetrical intervention, which is a safe and effective method of combating serious blood loss, especially for those patients who want to maintain their fertility.