Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization.
OBJECTIVE
To prospectively evaluate the efficacy and safety of emergency selective arterial embolization in the management of intractable primary postpartum hemorrhage.


METHODS
Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before embolization failed to stop the bleeding.


RESULTS
Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminution of external bleeding was observed in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women except the two who underwent hysterectomy. One woman became pregnant after embolization.


CONCLUSIONS
Emergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk surgery and allows maintenance of reproductive ability.
Department of Body and Vascular Imaging, Hôpital Lariboisière, AP-HP, Paris, France.
J P
JP
Pelage
O
O
Le Dref
J
J
Mateo
P
P
Soyer
D
D
Jacob
M
M
Kardache
H
H
Dahan
D
D
Repiquet
D
D
Payen
J B
JB
Truc
J J
JJ
Merland
R
R
Rymer
D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D007083:Iliac Artery / Q000000981:diagnostic imaging; D010053:Ovary / Q000098:blood supply; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000098:blood supply*; D014621:Vagina / Q000098:blood supply