title: Postpartum hemorrhage resulting from pelvic pseudoaneurysm: a retrospective analysis of 588 consecutive cases treated by arterial embolization.
abstract: OBJECTIVE
  This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.
  
  
  METHODS
  Eighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed.
  
  
  RESULTS
  The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82-4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery.
  
  
  CONCLUSIONS
  Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.
authors.affiliation: Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France, anthony.dohan@lrb.aphp.fr.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dohan
authors.forename: Philippe
authors.initials: P
authors.lastname: Soyer
authors.forename: Aqeel
authors.initials: A
authors.lastname: Subhani
authors.forename: Delphine
authors.initials: D
authors.lastname: Hequet
authors.forename: Yann
authors.initials: Y
authors.lastname: Fargeaudou
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
authors.forename: Mourad
authors.initials: M
authors.lastname: Boudiaf
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Barranger
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Dref
authors.forename: Marc
authors.initials: M
authors.lastname: Sirol
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D015901:Angiography, Digital Subtraction / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000187:drug effects*; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055988:Uterine Artery / Q000000981:diagnostic imaging / Q000187:drug effects*