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embolism postpartum

Marta Crous-Bou, Laura B Harrington, Christopher Kabrhel
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism, and a combination of environmental and genetic risk factors contributes to VTE risk. Within environmental risk factors, some are provoking (e.g., cancer, surgery, trauma or fracture, immobilization, pregnancy and the postpartum period, long-distance travel, hospitalization, catheterization, and acute infection) and others are nonprovoking (e.g., age, sex, race/ethnicity, body mass index and obesity, oral contraceptive or hormone therapy use, corticosteroid use, statin use, diet, physical activity, sedentary time, and air pollution)...
October 20, 2016: Seminars in Thrombosis and Hemostasis
Courtney Stanley Sundin, Lauren Bradham Mazac
Amniotic fluid embolism (AFE) is a rare but serious and potentially deadly complication of pregnancy that is unpreventable and unpredictable. Most AFE events occur during labor; however, approximately one third happen during the immediate postpartum period. Presentation is abrupt and thought to be an abnormal response to fetal materials entering maternal circulation through the placental insertion site. Care providers must recognize the signs and symptoms of AFE and react quickly in effort to treat potential complications...
October 13, 2016: MCN. the American Journal of Maternal Child Nursing
Raffaella Niola, Francesco Giurazza, Aleksandra Torbica, Emiliano Schena, Mattia Silvestre, Franco Maglione
Postpartum hemorrhages occur in 5 % of all deliveries. Open surgery and endovascular embolization techniques are the options commonly applied to face this life-threatening scenario. A cost analysis has been performed to compare the standard embolization endovascular approach, performed postpartum in emergency settlement, with a novel proposed preventive embolization approach, and performed in election in selected high-risk patients before the delivery. Two groups have been compared: 46 patients (non-preventive group) and 67 patients (preventive group)...
September 24, 2016: La Radiologia Medica
Hsin-Hsin Cheng, Leo Leung-Chit Tsang, Te-Yao Hsu, Chia-Te Kung, Chia-Yu Ou, Ching-Di Chang, Ching-Chang Tsai, Yu-Fan Cheng, Fu-Tsai Kung
BACKGROUND/PURPOSE: To assess the risk factors for intractable and controllable postpartum hemorrhage (PPH) and to evaluate the safety, efficacy, and outcome of transcatheter arterial embolization (TAE). METHODS: An emergency PPH rescue system including the 24-hour-available TAE was established in 2004. TAE with gelatine sponge particles placed on bilateral uterine or internal iliac arteries served as the first-line treatment for intractable PPH. Delivery methods, parity, causes of bleeding, clinical vital signs, coagulopathy, success rate, resumption of menstruation, and subsequent pregnancy outcome after TAE were recorded...
September 19, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Jung Kim, Jin Ho Choi, Bang Sup Shin, Joon Yeul Nam, Eun Ae Kang, Joo Seong Kim, Jin Hyeok Hwang, Jaihwan Kim
Acute pancreatitis rarely occurs in the postpartum period. Furthermore, there are very few reports of it after cesarean section delivery. A 35-year-old woman presented with dyspnea and abdominal distension on the third day after cesarean section delivery. Under a suspicion of acute pancreatitis, she was initially managed with conservative treatment. However, she developed intra-abdominal fluid collections and gastric bleeding, which were managed with percutaneous drainage, endoscopic hemostasis, and angiographic embolization...
September 25, 2016: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
F J Ruiz Labarta, M P Pintado Recarte, A Alvarez Luque, L Joigneau Prieto, L Perez Martín, M Gonzalez Leyte, F Palacio Abizanda, F Morillas Ramirez, A Perez Corral, L Ortiz Quintana, J De Leon-Luis
BACKGROUND: Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007. OBJECTIVES: To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH...
August 4, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Dániel Bereczki, Norbert Szegedi, Zoltán Szakács, István Gubucz, Zsolt May
An estimated 25-40% of ischemic strokes are classified as cryptogenic, which means the cause of the cerebral infarction remains unidentified. One of the potential pathomechanisms - especially among young patients with no cardiovascular risk factors - is paradoxical embolism through a patent foramen ovale. Pregnancy, cesarean delivery and the postpartum period are associated with an increased risk of cerebrovascular events. Factors that may contribute to ischemic strokes during gestation and puerperium include classic cardiovascular risk factors, changes in hemostaseology/hemodynamics, and pregnancy-specific disorders such as pre-eclampsia, eclampsia, postpartum cerebral angiopathy or peripartum cardiomyopathy...
2016: Neurologia i Neurochirurgia Polska
E Latif, S Adam, B Rungruang, A Al-Hendy, M P Diamond, E Rotem, J Cannell, P C Browne
Uterine artery embolization (UAE) is typically not indicated in the pre-operative management of pregnancies with a live fetus, because risk of fetal death from reduced uteroplacental blood flow. However, pre-operative UAE in pregnancies with a fetal demise poses no fetal risk, and may offer maternal benefits. Patients with placental abruption resulting in fetal demise are at high-risk for developing disseminated intravascular coagulation (DIC), which could have devastating complications such as peri-operative hemorrhage and death...
September 16, 2016: Journal of Neonatal-perinatal Medicine
Françoise Vendittelli, Chloé Barasinski, Bruno Pereira, Didier Lémery
BACKGROUND: Most estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies. Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management...
2016: BMC Pregnancy and Childbirth
Farida Chentli, Nadia Terki, Said Azzoug
AIM: Ovarian corticosteroid-producing tumors are exquisitely rare. Our aim was to describe the first case observed in our practice. CASE HISTORY: A 34-year-old female was referred for Cushing's syndrome (CS) occurring in the postpartum period. Clinical examination showed severe CS with diabetes mellitus, hypertension, and a large mass in the right lower abdomen. Biochemistry demonstrated corticotropin (ACTH)-independent CS (cortisol=1900ng/mL (n=50-250), ACTH<10pg/mL (n=20-46)) with estradiol and testosterone overproduction...
October 2016: European Journal of Endocrinology
Stephen E Lapinsky
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient...
September 2015: Obstetric Medicine
Yasutaka Konishi, Satoshi Yamamoto, Kei Sugiki, Hidetoshi Sakamoto, Shigehito Sawamura
Cesarean deliveries in patients with placenta accreta often are accompanied by life-threatening bleeding and sometimes death. A novel, multidisciplinary approach that uses uterine embolization after cesarean delivery recently has been advocated; however, embolization in the radiology department requires transfer of postoperative patients, which could increase maternal mortality and morbidity. In a case of severe placenta accreta, we planned a stepwise treatment, including cesarean delivery without separation of the placenta followed by intraoperative uterine arterial embolization in a hybrid operating room, followed by hysterectomy a few weeks after cesarean delivery...
September 15, 2016: A & A Case Reports
Cho Hee Kim, Shin Jae Lee, Gyeong Sik Jeon, Suk Ho Kang, Hyeon Chul Kim
Branches of the internal iliac artery or ovarian artery are the typical source of pelvic hemorrhage. The inferior mesenteric artery has been rarely reported as origin of pelvic bleeding. We present two cases of intractable intra-pelvic and vaginal bleeding following hysterectomy. One patient underwent a hysterectomy due to uncontrolled postpartum hemorrhage and another underwent a vaginal hysterectomy to treat vaginal prolapse. Both patients were subjected to angiography to control continuous vaginal bleeding after hysterectomy...
July 19, 2016: Journal of Minimally Invasive Gynecology
Elizabeth Janette Hamilton, Alistair Quentin Green, Jennifer Ann Cook, Henry Nash
This was a retrospective review of five years' data relating to patients referred to the Acute Medical Unit (AMU) of a large teaching hospital with suspected Pulmonary Embolism (PE) during pregnancy or 6 weeks postpartum. During this period, 210 patients in this group underwent half-dose perfusion scanning as investigation for possible PE and were managed via our ambulatory pathway. Pulmonary embolism was diagnosed in 5.2% of patients compared to 18% of non-pregnant patients identified in a previous audit. Half-dose Q scanning enabled exclusion of PE in almost 90% of patients without the need for further imaging...
2016: Acute Medicine
Martin H J Wiesen, Cornelia Blaich, Carsten Müller, Thomas Streichert, Roman Pfister, Guido Michels
Thromboembolic disorders frequently require antithrombotic treatment during pregnancy and lactation. Vitamin K antagonists and heparins are the treatment options of choice in breastfeeding women. Factors including the route of administration, discomfort during treatment, and fetal and neonatal safety affect women's choices about anticoagulant therapy. Direct-acting oral anticoagulants (DOACs) have emerged as alternatives to these agents and may offer advantages compared with vitamin K antagonists. As breastfeeding women were excluded from clinical trials evaluating DOACs, no safety and efficacy data are available for these special patients and, crucially, estimates for infant exposure are lacking...
July 2016: Chest
Moeun Son, Brett D Einerson, Patrick Schneider, Ian C Fields, William A Grobman, Emily S Miller
Objective Determine whether the indication for intrauterine balloon tamponade (IUBT) is associated with failure rates. Study Design Cohort study of women who underwent IUBT for postpartum hemorrhage (PPH) from 2007 to 2014. The indication was categorized as uterine atony or placental-site bleeding. Primary outcome was IUBT failure, defined as the need for uterine artery embolization or hysterectomy. Secondary outcomes were estimated blood loss (EBL) after balloon placement, transfusion of red blood cells (RBC), transfusion of fresh frozen plasma (FFP) and/or cryoprecipitate, and intensive care unit (ICU) admission...
July 1, 2016: American Journal of Perinatology
Anderson Lo, Peter St Marie, Parul Yadav, Elizabeth Belisle, Glenn Markenson
OBJECTIVE: Our objective was to evaluate the impact of uterine tamponade with a Bakri balloon on the rate of postpartum hysterectomy due to uterine atony. METHODS: We performed a retrospective cohort study of all deliveries >20 weeks gestation from January 2002 to March 2013 at Baystate Medical Center. Charts were reviewed to determine incidence of postpartum hysterectomy, Bakri balloon placement, uterine artery embolization (UAE) and the B-Lynch procedure. Patients with evidence of placenta accreta were excluded...
July 29, 2016: Journal of Maternal-fetal & Neonatal Medicine
Sally Easther, Fali Langdana, Richard Beasley, Dushyant Maharaj, James Entwisle, Peter Abels
AIM: To develop best practice clinical guidelines for the use of ventilation/perfusion (V/Q) scanning and computed tomography perfusion angiography (CTPA) in pregnancy and the postpartum period. METHOD: Retrospective analysis of the clinical findings and radiologic investigation for pulmonary embolism (PE) in obstetric women at Wellington Hospital from 2010 to 2012. RESULTS: Fifty-four women were investigated for PE with a V/Q scan or CTPA, including 29 antenatal women and 25 postnatal women...
2016: New Zealand Medical Journal
Drew Scribner, Robert Fraser
BACKGROUND: Acquired uterine arteriovenous malformation (AVM) is a rare cause of postpartum vaginal bleeding and can often be confused with retained products of conception (RPOC). Certain findings on ultrasound (US) increase the likelihood for AVM, such as hypoechoic areas in the myometrium and high velocity, multidirectional blood flow. Recognizing these changes on bedside US can cue the physician to send the patient for further studying and lead to the correct diagnosis. CASE REPORT: A 31-year-old, multigravida, multiparous female presented 5 weeks post-cesarean section with heavy, intermittent vaginal bleeding...
August 2016: Journal of Emergency Medicine
Omar Touhami, Sofiene Ben Marzouk, Mehdi Kehila, Laidi Bennasr, Aymen Fezai, Mohamed Badis Channoufi, Hayen El Magherbi
OBJECTIVES: To study the safety and effectiveness of pelvic packing in the control of post emergency peripartum hysterectomy (EPH) bleeding in a postpartum hemorrhage (PPH) setting. STUDY DESIGN: From 39 patients with a severe PPH leading to an EPH (January 2010-December 2013), we identified a group of 17 patients requiring a pelvic packing (packing group) and a second group of 22 patients not requiring a pelvic packing (non-packing group). For each group, transfusion requirements were recorded from time of PPH diagnosis to end of the surgical procedure (P1: Period 1) and from that point to the end management in the SICU (P2: Period 2)...
July 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
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