Postpartum hemorrhage treated with gelfoam slurry embolization using the superselective technique: immediate results and 1-month MRI follow-up.
OBJECTIVE
To evaluate the efficacy and safety of superselective embolization of the uterine arteries in a postpartum hemorrhage.


METHODS
Between November 2004 and January 2011, a total of 44 consecutive women (median ± standard deviation age 34 ± 3 years, range 23-41 years) were referred to our institution for postpartum intractable hemorrhage management. All patients were embolized with a microcatheter that was placed deep into the uterine arteries upstream of the cervical arteries. The embolic agent was a mixture of contrast medium and 5 × 5 × 5 cm pieces of gelfoam (Gelita-Spon) modified into a gelatin emulsion as follows: rapid mixing through a three-way stopcock with two 2.5-ml syringes. A 1-ml syringe was used for injection. One month after embolization, all patients underwent magnetic resonance imaging and clinical examination.


RESULTS
Technical and clinical success was obtained in all cases. Thirty-five patients experienced bleeding related to poor retraction of the uterus, 7 patients because of a tear of the cervix and 2 because of a vaginal hematoma. Pre- and postembolization red blood cell transfusions were (mean ± standard deviation [SD]) 6 ± 1.2 (range 3-8) U and 2 ± 0.7 (range 2-4) U, respectively. One-month magnetic resonance imaging follow-up revealed no sign of ischemic myometrium or necrosis, and no instances of uterine rupture and no pelvic vein thrombosis. Incidental findings included two small intramyometrial hematic collections. All uterine arteries were patent via magnetic resonance angiography. Seventeen patients had concomitant fibroids, all of which appeared hypovascular.


CONCLUSIONS
This technique permits good, safe clinical results with no marked damage to the uterine arteries or the uterus itself.
Interventional Radiology Department, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine - Assistance Publique-Hôpitaux de Paris - Hôpital Européen Georges-Pompidou, Paris, France. olivier.pellerin@egp.aphp.fr
Olivier
O
Pellerin
Anne-Sophie
AS
Bats
Massimiliano
M
Di Primio
Ana
A
Palomera-Ricco
Gabrielle
G
Pinot de Villechenon
Laure
L
Fournier
Jean-Yves
JY
Pagny
Bernard
B
Beyssen
Bertrand
B
Louail
Fabrice
F
Lécuru
Marc
M
Sapoval
D000328:Adult; D000792:Angiography / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D015642:Radiology, Interventional / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055988:Uterine Artery; D055357:Uterine Artery Embolization / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult