In this episode of the BackTable Podcast, host Dr. Ally Baheti and Dr. Daniel Sheeran discuss the management and treatment of peripartum and postpartum hemorrhage.

Dr. Sheeran highlights the importance of imaging-based diagnostics, particularly with MRI, to identify the source of bleeding and guide therapy. He also explains the need to employ a variety of techniques tailored towards each individual situation, which may involve utilizing different types of catheters, occlusion balloons, and embolics. He underlines the necessity to balance effective treatment with the preservation of uterine health, especially for women who may wish to have future pregnancies. In severe cases, he mentions the possibility of temporary aortic occlusion. As a final point, Dr. Sheeran argues that Interventional Radiology can play a crucial role in managing these types of cases and potentially avoiding hysterectomies.

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SHOW NOTES

00:00 - Introduction

03:00 - Breakdown of Types of Hemorrhages

03:26 - Understanding Peripartum Hemorrhage

04:05 - Discussion on Postpartum Hemorrhage

07:52 - Technical Details of Balloon Occlusion

08:00 - Procedure for Peripartum Hemorrhage

21:15 - Blood Loss in Medical Procedures

22:48 - Uterine Artery Embolization

27:10 - Post-Procedure Follow Up and Fertility Concerns

30:05 - Technical Points for Newcomers in the Field

36:12 - The Role of REBOA in Treating Postpartum Hemorrhage

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RESOURCES

The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276355/

Magnetic Resonance Imaging of Placenta Accreta Spectrum: A Step-by-Step Approach:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817633/

Role of interventional radiology in placenta accreta spectrum (PAS) disorders:

https://www.sciencedirect.com/science/article/pii/S1521693421000146

Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta:

https://pubmed.ncbi.nlm.nih.gov/21598085/

Aberrant Ovarian and Uterine Feeding from the Renal Artery at the End of Gestation: Two Cases:

https://www.jvir.org/article/S1051-0443(10)00863-8/fulltext

Uterine Fundal Blood Supply from an Aberrant Left Ovarian Artery Originating from the Inferior Mesenteric Artery: Implications for Uterine Artery Embolization:

https://www.jvir.org/article/S1051-0443(10)00191-0/fulltext

Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6948071/

Uterine artery embolisation: fertility, adenomyosis and size – what is the evidence?:

https://cvirendovasc.springeropen.com/articles/10.1186/s42155-023-00353-2

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Proximal Aortic Control in Patients With Severe Hemorrhage and Arrest:

https://pubmed.ncbi.nlm.nih.gov/28973104/

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA):

https://prytimemedical.com/clinical/reboa/

Resuscitative endovascular balloon occlusion of the aorta (REBOA) for life-threatening postpartum hemorrhage: A nationwide observational study in Japan:

https://pubmed.ncbi.nlm.nih.gov/35444149/

Efficacy of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage control in patients with abnormally invasive placenta: a historical cohort study:

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05649-8

An elective hybrid suite approach to the management of placenta accreta-associated postpartum hemorrhage (PPH):

https://www.jvir.org/article/S1051-0443(13)00311-4/fulltext

The role of interventional radiology in primary postpartum hemorrhage:

https://www.jstage.jst.go.jp/article/jsshp/4/2/4_HRP2015-016/_article