title: Failed pelvic arterial embolization for postpartum hemorrhage: clinical outcomes and predictive factors.
abstract: OBJECTIVE
  To evaluate clinical outcomes of failed pelvic arterial embolization (PAE) and determine predictive factors associated with this failure in the treatment of postpartum hemorrhage (PPH).
  
  
  METHODS
  This retrospective study included all consecutive patients who underwent PAE for life-threatening PPH between March 2004 and January 2011 at a tertiary-care center. Medical records and imaging studies were reviewed to identify cases of failed PAE and their clinical outcomes. Multiple parameters were compared between the failed and successful PAE groups, and multivariate analysis was performed to determine the predictive factors associated with failed PAE.
  
  
  RESULTS
  PAE was performed in 257 patients (mean age, 32 y; range, 20-40 y). A total of 24 cases of PAE involved a failure to achieve hemostasis (9.3%). Patients in the failed PAE group experienced more major complications than those in the successful PAE group (37.5% [nine of 24] vs 9.4% [22 of 233]). Factors more frequently found in failed PAE included hemodynamic instability, hemoglobin level lower than 8g/dL, disseminated intravascular coagulation (DIC), and extravasation detected on angiography. After multivariate analysis, DIC emerged as the only significant predictive factor (odds ratio, 6.569; 95% confidence interval, 1.602-26.932; P = .009).
  
  
  CONCLUSIONS
  PAE is an effective treatment for medically intractable PPH. However, PAE failed in a high percentage of patients and was commonly associated with major complications. DIC was the only significant predictor of failed PAE.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyenggi-do 463-707, Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.forename: Nak Jong
authors.initials: NJ
authors.lastname: Seong
authors.forename: Sung-Gwon
authors.initials: SG
authors.lastname: Kang
authors.forename: Seung-Won
authors.initials: SW
authors.lastname: An
authors.forename: Yun-Sin
authors.initials: YS
authors.lastname: Kim
authors.forename: Young-Nam
authors.initials: YN
authors.lastname: Woo
mesh_terms: D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology*; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome