Transarterial Embolization: Alternative Treatment of Early and Late Postpartum Hemorrhage at a Single Tertiary Center

Abstract

Objective: To evaluate the efficacy of uterine artery embolization (UAE) in the treatment of postpartum hemorrhage (PPH).
Methods: All women who underwent UAE for the treatment of PPH between August 2008 and February 2016 were included. The patients were divided into early and late PPH defined by the onset of bleeding. All UAE procedures were performed by experienced interventional radiologists. Electronic medical records and radiological images were reviewed for data collection. Statistically significant associations between angiographic findings and the onset of PPH were evaluated.
Results: Total twenty-one women were enrolled in the study. The mean age of the patients was 30.1 years (range 16-42 years).Total 23 UAE procedures were performed in 21 women. Major clinical presentation was vaginal bleeding in 19 patients (90.5%) and hypovolemic shock was found in 10 patients (47.6%). Eight patients (38.1%) were in early PPH group and thirteen patients (61.9%) were in late PPH group. Five women underwent hysterectomy before UAE. Active contrast extravasation was a common finding associated with early PPH (50%) while pseudoaneurysms were commonly found in late PPH (53.8%) (p=0.016). The overall technical and clinical success rate were 100%. However, two women required repeated UAE after gelatin sponge embolization for active extravasation due to re-bleeding. No immediate complication of UAE was found in our study.
Conclusion: UAE is a safe and effective treatment for both early and late PPH. Various embolic materials can be used but permanent embolic material is preferable in patient with extravasation.