2:18 PM Abstract No. 156 - Techniques and outcomes of uterine artery embolization in the management of post-partum or post-abortion hemorrhage secondary to uterine vascular malformations

Abstract

Purpose To evaluate techniques and outcomes of uterine artery embolization (UAE) in the management of post-partum or post-abortion hemorrhage secondary to uterine vascular malformations (UVM). Materials and Methods The study population consisted of all patients who had UAE for post-partum or post-abortion hemorrhage at any one of our three hospitals over a 102 month period (Jan 2003 to July 2011). UVMs were diagnosed using standardized criteria with gray-scale and doppler ultrasound. Embolic agents used included: metallic coils, microcoils, polyvinyl alchohol (PVA) particles and microspheres, absorbable gelatin sponge, and Gelfoam. Patient demographics, prenatal history, techniques and agents, efficacy, hospital stay, complications, patient satisfaction, menses and subsequent pregnancies were recorded. Results During the study period, there were 25 patients who had 32 UAE procedures. Mean age was 26.6 years. Bilateral UAE was performed in 11 patients, and unilateral in 14. Embolic agents used were: microcoils (n = 8, 32%), microcoils and gelfoam pledgets (n = 3, 12%), microspheres (n = 3, 12%), glue (n = 1, 4%), polyvinyl alcohol particles (PVA) (n =12, 48%), PVA and gelfoam pledgets (n = 5, 20%). 17 (68%) had no bleeding recurrence. 8 (32%) experienced rebleeding post-embolization, which was either treated supportively or required further intervention with repeat embolization, DandC, or hysterectomy. On follow-up (mean 29 months, range 3-58 months): 7 patients were lost to follow up or refused to comment. Subjective level of satisfaction on a scale of 1-10 was 8.5 (range 7-10). 8 patients became pregnant 9 times. 2 had elective abortions. 6 had 7 uneventful intrauterine pregnancies with normal infants. Conclusion UAE is safe and effective in patients with post-partum or post-abortion hemorrhage secondary to a UVM, with preservation of fertility, and should be considered the first line of treatment. UAE is effective with a myriad of embolic agents, including microcoils, not just PVA and glue as described in previous literature.