بررسی اثربخشی و عوارض آمبولیزاسیون شریان رحمی در بیماران مبتلا به خونریزی دیررس پس از زایمان (مطالعه نیمه‌تجربی)

نوع مقاله : اصیل پژوهشی

نویسندگان

1 متخصص زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

2 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

3 استادیار گروه رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

10.22038/ijogi.2022.20422

چکیده

مقدمه: یکی از شایع‌ترین علل مرگ‌و‌میر مادران در جهان، خونریزی پس از زایمان است. تاکنون مطالعه‌ای در خصوص مقایسه تأثیر دو ماده آمبولیزان پلی‌وینیل الکل و ژل فوم بر الگوی قاعدگی پس از آمبولیزاسون شریان رحمی در ایران انجام نشده است، لذا مطالعه حاضر با هدف بررسی اثر‌بخشی و عوارض آمبولیزاسیون شریان رحمی در بیماران مبتلا به خونریزی پس از زایمان انجام گرفت.
روشکار: این مطالعه نیمه‌تجربی در سال‌های 99-1398 بر روی 70 نفر از بیماران مبتلا به خونریزی دیررس پس از زایمان مراجعه‌کننده به مراکز آموزشی و درمانی اصفهان، بیمارستان‌های الزهراء (س) و خورشید اصفهان انجام گرفت. 30 نفر با ماده آمبولیزان ژل فوم و 40 نفر با ماده آمبولیزان پلی‌وینیل الکل تحت آمبولیزاسیون شریان رحمی قرار گرفتند. بیماران به‌مدت 6 ماه پیگیری شدند و الگوی قاعدگی و عوارض آمبولیزاسیون شریان رحمی در دو گروه مقایسه شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های تی مستقل، کای دو و آزمون دقیق فیشر انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافتهها: در این مطالعه میزان موفقیت بالینی 4/91% و میزان موفقیت فنی 100% بود. الگوی قاعدگی نرمال در مجموع دو گروه در سه ماهه اول 7/61% و پس از سه ماهه دوم 4/91% گزارش شد. الگوی قاعدگی پس از 6 ماه پیگیری بین دو گروه تفاوت معنی‌داری نداشت (018/0=p). میزان عوارض کلی 3/13% بود که 8/10% سندرم پس از آمبولیزاسیون و 5/2% ایسکمی موضعی ناحیه تناسلی خارجی بود.
نتیجهگیری: آمبولیزاسیون شریان رحمی، یک روش مؤثر و ایمن جهت درمان زنان مبتلا به خونریزی دیررس پس از زایمان می‌باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The efficacy and complications of uterine artery embolization in patients with late postpartum hemorrhage (Quasi-experimental study)

نویسندگان [English]

  • Soheila Aghataheri 1
  • Seyyedeh Zahra Allameh 2
  • Mohamad Saleh Jaafarpisheh 3
1 Gynecologist, Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Assistant Professor, Department of Radiology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
چکیده [English]

Introduction: One of the most common causes of maternal death worldwide is postpartum hemorrhage (PPH). So far, no study has been performed in Iran to compare the effects of polyvinyl alcohol and foam gel embolizers on menstrual pattern after uterine artery embolization. Therefore, this study was performed with aim to evaluate the efficacy and complications of uterine artery embolization (UAE) in patients with late PPH.
Methods: This quasi-experimental study was performed on 70 patients with late postpartum hemorrhage referred to the Isfahan Educational and Medical Centers, Al-Zahra and Khorshid hospitals in 2019-2020. In this study, 30 patients with foam gel embolizer and 40 patients with polyvinyl alcohol embolizer underwent uterine artery embolization. Patients were followed for 6 months; menstrual pattern and complications of UAE were compared in the two groups. Data were analyzed by SPSS statistical software (version 22) and Independent t-test, Chi-square and Fisher's exact test.  P<0.05 was considered statistically significant.
Results: In this study, the clinical success rate was 91.4% and the technical success rate was 100%. The pattern of normal menstruation in the two groups after first three months was 61.7% and after the second three months was 91.4%. There was no significant difference between the two groups after six months of follow-up (p =0.18). The overall complication rate was 13.3%, of which 10.8% was post-embolization syndrome and 2.5% was local ischemia of the external genitalia.
Conclusion: UAE is an effective and safe method for treatment of women with late PPH.

کلیدواژه‌ها [English]

  • Gelfoam
  • Polyvinyl alcohol
  • Postpartum hemorrhage (PPH)
  • Uterine artery embolization (UAE)
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