Transcatheter arterial embolization outperforms surgery in reducing blood transfusions for postpartum vulvovaginal hematoma

Postpartum vulvovaginal hematoma is a complication of vaginal delivery that may progress to life-threatening conditions. However, the management of hematomas, including conservative therapy, surgery, and arterial embolization, is yet to be standardized. This study aimed to: (1) evaluate hematoma fea...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2024-03
Main Authors: Takahashi, Tsukasa, Tomita, Hasumi, Hamada, Hirotaka, Tadakawa, Mari, Iwama, Noriyuki, Saito, Masatoshi
Format: Article
Language:English
Subjects:
blood transfusion
surgery
therapeutic intervention
transcatheter arterial embolization
vulvovaginal hematoma
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Summary:Postpartum vulvovaginal hematoma is a complication of vaginal delivery that may progress to life-threatening conditions. However, the management of hematomas, including conservative therapy, surgery, and arterial embolization, is yet to be standardized. This study aimed to: (1) evaluate hematoma features that can be treated conservatively, and (2) determine whether surgery or transcatheter arterial embolization is superior in reducing blood transfusion. This cross-sectional study included postpartum women transferred to Tohoku University Hospital, Japan, between January 2016 and September 2023 for postpartum vulvovaginal hematomas. Notably, all patients except 1 underwent contrast-enhanced computed tomography. The patients were classified into the following groups: (1) the conservative group who received neither surgery nor transcatheter arterial embolization and (2) the therapeutic intervention group who received surgery or transcatheter arterial embolization. The primary analysis included all patients. Variables for the choice of therapeutic intervention, including the shock index, hemoglobin concentration at arrival, hematoma size, and presence of extravasation, were assessed using a modified Poisson regression model. The secondary analysis included patients who received therapeutic intervention (ie, surgery or transcatheter arterial embolization). Variables for estimating the total amount of blood transfusion, including shock index, hemoglobin concentration at arrival, hematoma size, type of intervention, and presence of extravasation, were analyzed using multiple linear regression. Fifty-seven cases were included in this study. Patients underwent conservative treatment (n=19), surgery (n=11), or transcatheter arterial embolization (n=27). In primary analysis, only the presence of extravasation was significantly associated with the choice of therapeutic intervention (adjusted risk ratio [95% confidence interval], 5.30 [1.53–18.37]). In the secondary analysis, the choice of surgery as a therapeutic option (unstandardized coefficient [95% confidence interval], 4.64 [1.15–8.13]; reference: transcatheter arterial embolization), lower hemoglobin concentration at arrival (−2.84 [−4.71 to −0.97]; 1 g/dL increment), and larger hematoma size (3.38 [1.23–5.53]; 100 cm3 increments) were significantly associated with increased blood transfusion. When a vulvovaginal hematoma does not exhibit extravasation, it can be treated conservatively regardless of size. When a
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2024.03.016