title: Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors?
abstract: OBJECTIVE
  To retrospectively identify predictive factors of recurrent bleeding within 24 h after uterine artery embolization (UAE) for postpartum hemorrhage (PPH).
  
  
  METHODS
  A total of 194 patients underwent UAE for PPH between August 1999 and April 2009 at our institution. Twelve patients experienced recurrent bleeding within the next 24 h; a second attempt at UAE was thus necessary, which was successful in 10 cases. In two cases, hemostatic hysterectomy was performed. Epidemiological, gynecological-obstetrical, anatomic, and biological data were analyzed.
  
  
  RESULTS
  Complete data were available for 148 of the 194 (76%) included patients. Sixty-four (43%) were primiparous, 18 (12.2%) had a placenta accreta, 21 (14%) had a coagulopathy, and 28 (18.9%) had an anatomic variant of the uterine arterial vasculature. Mean age and pregnancy term were similar in both recurring and nonrecurrent bleeding groups. After multivariate analysis, three criteria emerged as risk factors of recurrent bleeding: primiparity (10 patients, 83%; odds ratio [OR]=18.84; P=0.014), coagulation disorders (6 patients, 50%; OR=12.08; P=0.006), and anatomic variant of the uterine arterial vasculature (28 patients; OR=9.83; P=0.003).
  
  
  CONCLUSIONS
  Search for uterine collaterals must be performed before UAE for PPH. Primiparity and coagulation disorders increase the risk of recurrent bleeding after UAE for PPH.
authors: Department of Radiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand, France. sebbros@wanadoo.fr
authors: Sébastien
authors: S
authors: Bros
authors: Pascal
authors: P
authors: Chabrot
authors: Adrian
authors: A
authors: Kastler
authors: Lemlih
authors: L
authors: Ouchchane
authors: Lucie
authors: L
authors: Cassagnes
authors: Denis
authors: D
authors: Gallot
authors: Louis
authors: L
authors: Boyer