Emergency Arterial Embolization in the Management of Primary Postpartum Hemorrhage

Abstract

Objective: To evaluate the efficacy of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage. Material(s) and Method(s): A retrospective review was undertaken of 25 women with life-threatening primary postpartum hemorrhage who underwent uterine embolization from May 1992 to May 2002. In all cases, hemostatic embolization was perlormed because of intractable hemorrhage which could not be controlled with vaginal packing and administration of uterotonic drugs. Result(s): The major clinical indications for transcatheter embolization included uterine atony in 12 women, a genital tract lesion (vaginal or cervical tears) in 7 women, placenta previa in 2 women, and placenta accreta in 2 women. Two patients were known to have myomas. All were already in-house. Twenty-four women were successfully treated using transcatheter arterial embolization with gelatin sponge particles, and 1 patient expired due to irreversible shock. Conclusion(s): Transcatheter arterial embolization therapy is a safe and effective means for treating hemodynamically stable patients. It may fail when patients have an unstable hemodynamic status with uncontrollable hemorrhaging.