title: Outcome of pelvic arterial embolization for postpartum hemorrhage: A retrospective review of 117 cases.
abstract: OBJECTIVE
  The aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH).
  
  
  METHODS
  We retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013.
  
  
  RESULTS
  In our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy.
  
  
  CONCLUSIONS
  PAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH.
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Ji Yoon
authors.initials: JY
authors.lastname: Cheong
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kong
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Joo Hyuk
authors.initials: JH
authors.lastname: Son
authors.affiliation: Department of Radiology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Je Hwan
authors.initials: JH
authors.lastname: Won
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jeong In
authors.initials: JI
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Haeng Soo
authors.initials: HS
authors.lastname: Kim
keywords: Hemostatic hysterectomy; Pelvic arterial embolization; Postpartum hemorrhage