J Korean Radiol Soc.  2003 Jun;48(6):459-465. 10.3348/jkrs.2003.48.6.459.

Postpartum Bleeding: Efficacy of Endovascular Management

• Lee SY
• Ko GY
• Song HY
• Gwon DI
• Sung KB
• Yoon HK

• KMID: 1833709
• DOI: http://doi.org/10.3348/jkrs.2003.48.6.459

Abstract

PURPOSE
To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding.
MATERIALS AND METHODS
Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented.
RESULTS
Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due to rebleeding on the 12th and 13th day, respectively, after embolization.
CONCLUSION
Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

Keyword

Interventional procedures, embolization; Pregnancy, complications; Arteries, therapeutic blockade

MeSH Terms

Angiography
Arteries
Gelatin Sponge, Absorbable
Hemorrhage*
Humans
Hysterectomy
Iliac Artery
Polyvinyl Alcohol
Postpartum Period*
Retrospective Studies
Sepsis
Uterine Artery
Polyvinyl Alcohol