Abstract
Post partal hemorrhage remains a leading cause of maternal mortality throughout the world. Uterine atony, lower genital tract lacerations and abnormal placentation account for the majority of cases. Atonic uterus is usually controlled satisfactorily using oxytocin drugs and prostaglandin analogues. Specific surgical repair is effective to treat cervical tears and curettage may be sufficient to remove retained placental tissue. For patients whose clinical condition continues to deteriorate, ligation of the hypogastric artery or even hysterectomy is often the favored treatment. The successful use of arterial embolization was first reported in 1979. Since then many reports have emphasized the advantages of embolization over surgery in the management of severe postpartal hemorrhage. The main blood supply to the uterus is provided by the uterine arteries. However, additional blood supply from the ovarian or round ligament arteries may account for technical failure or recurrence of bleeding. The overall success rates of embolization using mainly gelatin sponge pledgets range between 80 and 95% to treat bleeding following cesarean section and in case of uterine atony respectively. Pluridisciplinary management for these patients should be realized in highly specialized centers open 24 hours a day only.
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