title: Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four-year experience.
abstract: BACKGROUND
  To retrospectively evaluate the efficacy and safety of emergent and prophylactic arterial embolization for obstetric hemorrhage within the past 4 years.
  
  
  METHODS
  We retrospectively collected 21 obstetric patients with treatment of selective arterial embolization between 1999 and 2002. Two groups of patients were identified. The first group consisted of 15 patients who experienced postpartum hemorrhage and underwent emergent embolization. The second group was made up of 6 patients who underwent prophylactic embolization with risk factors of severe obstetric bleeding. They had abnormal placentation antepartum diagnosed and accepted termination of pregnancy followed by hysterectomy.
  
  
  RESULTS
  In the first group, 12 of 15 cases had a favorable outcome treated by single embolization session. One patient expired 4 days after embolization due to severe disseminated intravascular coagulopathy and multiple organ failure. One retained placenta with recurrent bleeding was controlled by repeated selective arterial embolization. One uterine subinvolution with persistent mild bleeding and genital tract infection was improved by conservative treatment. Further surgical procedure was not necessary for all cases. One woman delivered her next baby 13 months after embolization. In the second group, all women had abnormal placentation with histopathological confirmation, including 1 accreta, 3 increta, and 2 percreta. No immediate complication was noted after embolization. The estimated blood loss during operation ranged from 300 to 3000 mL (mean, 1770 mL).
  
  
  CONCLUSIONS
  Our study indicates that selective arterial embolization should be the early management for intractable postpartum hemorrhage after conservative treatment fails and before more invasive surgical intervention is considered. Our experience also confirms the effectiveness and safety of prophylactic selective arterial embolization for anticipated high morbidity or mortality of obstetric surgery.
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, Taiwan, ROC.
authors.forename: Yung-Yi
authors.initials: YY
authors.lastname: Cheng
authors.forename: Jen-I
authors.initials: JI
authors.lastname: Hwang
authors.forename: Siu-Wan
authors.initials: SW
authors.lastname: Hung
authors.forename: Yeu-Sheng
authors.initials: YS
authors.lastname: Tyan
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Yang
authors.forename: Ming-Ming
authors.initials: MM
authors.lastname: Chou
authors.forename: San-Kan
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome