title: Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for the treatment of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes.
  
  
  METHODS
  This retrospective single-center study was institutional review board approved, and informed consent was waived. Outcomes were analyzed in 251 patients who underwent PAE for primary PPH between January 2000 and February 2011. Mode of delivery, causes of bleeding, detailed laboratory and treatment records, and clinical outcomes were recorded. Clinical success was defined as cessation of bleeding after initial session of PAE without the need for additional PAE or surgery. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.
  
  
  RESULTS
  The clinical success rate was 86.5% (217 of 251). Among the 34 failed cases, 12 underwent repeat PAE, 16 underwent additional surgery, and three recovered with conservative management. Overall bleeding control was achieved in 98.0% (246 of 251) of the patients. Overall mortality was 2% (five of 251) after the first (n = 3) or second (n = 1) session of PAE or additional surgery (n = 1). Among the 113 patients with long-term follow-up, 110 (97.3%) maintained a regular menstrual cycle and 11 had successful pregnancies. Univariate analysis showed that cesarean section delivery, disseminated intravascular coagulation (DIC), and massive transfusion of more than 10 red blood cell units were related to failed PAE. Multivariate analysis showed that DIC (odds ratio, 0.36; P = .04) and massive transfusion (odds ratio, 0.10; P < .001) were significantly related to clinical failure.
  
  
  CONCLUSIONS
  PAE is safe and effective for managing primary PPH. Patients with DIC and massive transfusion were likely to have poor results after PAE.
authors: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea.
authors: Ha Young
authors: HY
authors: Lee
authors: Ji Hoon
authors: JH
authors: Shin
authors: Jinoo
authors: J
authors: Kim
authors: Hyun-Ki
authors: HK
authors: Yoon
authors: Gi-Young
authors: GY
authors: Ko
authors: Hye-Sung
authors: HS
authors: Won
authors: Dong Il
authors: DI
authors: Gwon
authors: Jin Hyoung
authors: JH
authors: Kim
authors: Kyung Sik
authors: KS
authors: Cho
authors: Kyu-Bo
authors: KB
authors: Sung
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media