Abstract No. 214: Pelvic arterial embolization for primary postpartum hemorrhage: Outcome in 225 patients at a single institution

Abstract

To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for treatment of primary postpartum hemorrhage (PPH), and to determine the factors associated with clinical outcomes. Between January 2000 and June 2010 a retrospective analysis of 225 patients (mean age, 32 years) who underwent PAE for primary PPH was conducted. Mode of delivery, cause of primary PPH, detailed laboratory and treatment records, and clinical outcomes were collected. Clinical success was defined as cessation of bleeding following initial session of PAE without need for additional PAE or surgery. Univariate and multivariate analysis was conducted to determine the factors related with clinical outcomes. Clinical success was achieved in 194 patients (86.2%). In 31 patients without clinical success, ten and 16 patients underwent repeat PAE and additional surgery, respectively. In two patients, bleeding was controlled with conservative management and the remaining three died from hypovolemic shock after first session of PAE. Overall bleeding control was achieved in 97.8% (220/225). Overall mortality was 2.2% (5/225) after first (n=3) or second (n=1) session of PAE or additional laparotomy (n=1). In 113 patients with long-term follow-up, regular menstruation started in 110 patients (97.3%), and 11 patients had been pregnant. On univariate analysis, caesarean section delivery, associated disseminated intravascular coagulation (DIC), and short interval from delivery to PAE were related with high rate of clinical failure. On multivariate analysis, presence of DIC was significantly related with clinical failure. PAE for primary PPH is safe and effective with bleeding control after initial session of PAE in 86.2% of the patients. Patients with caesarean section, associated DIC, and short interval from delivery to PAE were likely to have poor results after PAE.