Arterial Embolization for Primary Postpartum Hemorrhage

Abstract

To evaluate the efficacy and safety of arterial embolization (AE) for treatment of primary postpartum hemorrhage (PPH), and the factors associated with clinical success. A retrospective analysis of all patients undergoing AE for primary PPH at three institutions (N = 43) from 1996 through 2007 was conducted. Patients with an antepartum diagnosis of invasive placenta were excluded from the study. Mean patient age was 31 years +/- 5 (range, 21-40 y). Eighteen women (42%) were primiparous. Delivery details, transfusion requirements, hematology and coagulation results, embolization details, and clinical outcomes were collected. Clinical success was defined as cessation of bleeding without the need for repeat embolization, laparotomy, or hysterectomy after embolization; or death. The Fisher exact test was used to analyze nonparametric data. The clinical success rate was 79% (n = 34). Four patients underwent successful repeat embolization. Two of 35 patients who had not undergone hysterectomy before embolization underwent hysterectomy for continued bleeding (without repeat embolization). One underwent hysterectomy 2 weeks after AE for uterine necrosis. One of eight patients who had undergone hysterectomy before AE required a laparotomy for a large retroperitoneal hematoma, and one patient died from cerebral anoxia secondary to hypotension despite repeat embolization. Clinical success was not related to mode of delivery, cause of PPH, transfusion requirements, time from delivery to embolization, or hysterectomy before AE (P > .05). Patients with active extravasation visualized angiographically were more likely to require repeat embolization (five of 13 [38%] vs 0 of 30 without extravasation; P < .01). AE for primary PPH is safe and effective. Repeat embolization may be necessary in patients with active extravasation on angiography.