title: Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage.
abstract: OBJECTIVE
  Primary postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality around the world. Most patients can be managed conservatively, but patients with intractable bleeding require more aggressive treatment. In these cases uterine artery embolisation (UAE) has proven to be a useful tool to control PPH. The reported success rate of UAE is over 90% with only minor complications. In this case series we studied the effectiveness and complications of UAE.
  
  
  METHODS
  Retrospective analysis of a case series.
  
  
  METHODS
  Case series in a large peripheral hospital in the Netherlands.
  
  
  METHODS
  Eleven patients who were treated with UAE for intractable PPH from November 2004 to February 2008.
  
  
  METHODS
  In this paper we review the results of all patients treated with UAE for intractable PPH in our hospital and focus on the two cases with adverse outcomes.
  
  
  METHODS
  Effectiveness, causes of failure of UAE, complications.
  
  
  RESULTS
  Nine out of eleven patients were treated successfully with UAE. One patient needed an emergency hysterectomy for intractable bleeding. In the aftermath she developed a vesicovaginal fistula (VVF). Another patient suffered a major thrombo-embolic event of the right leg, for which she underwent embolectomies and despite fasciotomy a necrotectomy.
  
  
  CONCLUSIONS
  UAE is a valuable tool in managing major PPH and in most cases it can replace surgery and thus prevent sacrification of the uterus. However, due to blood supply of the uterus by one of the ovarian or aberrant arteries, UAE might fail to control the bleeding. In addition, serious complications such as a thrombo-embolic event or VVF may occur. We hereby present a case of migration of an embolus from the site of re-embolisation into the femoral artery requiring immediate intervention to prevent the loss of the lower leg. This complication demonstrates that gelatine sponge particles could migrate from the internal iliac artery into the external iliac artery.
authors.affiliation: Department of Obstetrics and Gynaecology, Alber Schweitzer Hospital, Dordrecht, The Netherlands. marloesmaassen@yahoo.com
authors.forename: M S
authors.initials: MS
authors.lastname: Maassen
authors.forename: M D A
authors.initials: MD
authors.lastname: Lambers
authors.forename: R P
authors.initials: RP
authors.lastname: Tutein Nolthenius
authors.forename: P H M
authors.initials: PH
authors.lastname: van der Valk
authors.forename: O E
authors.initials: OE
authors.lastname: Elgersma
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007083:Iliac Artery; D007866:Leg / Q000098:blood supply; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D012086:Reoperation / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects*; D014599:Uterus / Q000098:blood supply*; D054556:Venous Thromboembolism / Q000209:etiology; D014719:Vesicovaginal Fistula / Q000209:etiology
chemical_list: D003287:Contrast Media