Abstract No. 259: Pelvic arterial embolization in treatment of postpartum hemorrhage: clinical outcomes and predictive factor for failed embolization

Abstract

This study aims to evaluate clinical outcomes of failed pelvic arterial embolization in treatment of postpartum hemorrhage (PPH) and to determine predictive factors associated with failed procedures. Two hundred forty-six consecutive patients (age range 22-41 years; mean 33 years) who underwent pelvic arterial embolization for PPH were enrolled in this retrospective study. The medical records and imaging studies were reviewed to evaluate the incidence of failed embolization, subsequent intervention, complication, and mortality. Multiple covariates including demographic data, cause of PPH, types of delivery, hemodynamic stability, presence of disseminated intravascular coagulation (DIC), blood transfusion, angiographic findings, and embolized vessels were used in multivariate analyses to determine predictive factors associated with failed embolization. A total 23 embolization procedures failed to achieve hemostasis (9.3%). The patients subsequently underwent hysterectomy (n=10), repeat embolization (n=9), remnant placenta evacuation (n=2), and vaginal laceration repair (n=2) for persistent bleeding. Eight patients (34.8%, 8/23) suffered from major complications including extremity paresthesia (n=3), cerebral ischemia (n=3), and pelvic abscess (n=2). One patient died of hypovolemic shock (4.3%, 1/23). DIC was independently associated with failed embolization (P=0.004, OR 0.219, 95% CI 0.078-0.621). Failed pelvic arterial embolization for PPH is not uncommon and frequently associated with significant morbidity and mortality. DIC is a major predictive factor for failed embolization.