title: Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage.
abstract: OBJECTIVE
  To estimate what factors are associated with a failed pelvic arterial embolization for postpartum hemorrhage and to attempt to estimate efficacy of pelvic arterial embolization in rare conditions.
  
  
  METHODS
  This was a retrospective cohort study including all consecutive women who underwent pelvic arterial embolization trial for postpartum hemorrhage between 1994 and 2007 at a tertiary care center. Pelvic arterial embolization failure was defined as the requirement for subsequent surgical procedure to control postpartum hemorrhage.
  
  
  RESULTS
  Pelvic arterial embolization was attempted in 0.3% of deliveries by the same radiologist in 87% of cases. Failures occurred in 11 of 100 cases (11%) and in 4 of 17 cases (24%) of placenta accreta or percreta. The major complication rate after pelvic arterial embolization was low (3%). Fifty patients (50%) were transferred from nine other institutions. Pelvic arterial embolization was performed in 11 cases (11%) after a failed conservative surgical procedure and in eight cases (8%) for secondary postpartum hemorrhage, with success rates of 91% and 88%, respectively. Pelvic arterial embolization demonstrated a patency throughout one ligated pedicle in 9 of the 11 cases of failed conservative surgical procedure (82%). Twin pregnancy, chorioamnionitis, operative vaginal delivery, hospital-to-hospital transfer, nature of embolizing agent and arteries embolized, failed surgical procedure, secondary postpartum hemorrhage, cause of postpartum hemorrhage, and more than one pelvic arterial embolization were not found to be significantly associated with failed pelvic arterial embolization.
  
  
  CONCLUSIONS
  The only factors significantly associated with failed pelvic arterial embolization were a higher rate of estimated blood loss (more than 1,500 mL) and more than 5 transfused red blood cell units. Attempted pelvic arterial embolization after a failed vessel ligation procedure and for a secondary postpartum hemorrhage is a good option with high success rates.
authors.affiliation: From the Department of Obstetrics and Gynecology, Rouen University Hospital, Charles Nicolle, Rouen, France; the Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France; and the Department of Radiology, Rouen University Hospital, Charles Nicolle, Rouen, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
authors.forename: Alexis
authors.initials: A
authors.lastname: Gromez
authors.forename: Erick
authors.initials: E
authors.lastname: Clavier
authors.forename: Benoît
authors.initials: B
authors.lastname: Resch
authors.forename: Eric
authors.initials: E
authors.lastname: Verspyck
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055357:Uterine Artery Embolization; D055815:Young Adult