title: [Role of arterial embolization in the management of postpartum hemorrhage].
abstract: OBJECTIVE
  To provide recommendations regarding the use of arterial embolization in the management of post partum hemorrhage.
  
  
  METHODS
  A literature search was conducted using the Pubmed, Medline and Embase databases and the Cochrane Library (study period 1979 to June 2014).
  
  
  RESULTS
  Selective embolization of both uterine arteries without microcatheter is recommended (professional consensus). Embolization should be performed using gelatin sponge pledgets rather than gelatin sponge slurry or powder (grade C). Control of hemorrhage can be expected in 70 to 100% of cases after embolization (EL3). Control of hemorrhage is obtained in 85 to 100% of cases (EL3). Arterial embolization is recommended in case of uterine atony after failure of uterotonic drugs particularly after vaginal delivery, in case of cervical hemorrhage, vaginal thrombus of cervico-vaginal tear in case of failed surgical repair or if surgery is not feasible (grade C). Pseudoaneurysm of the uterine artery is a good indication for embolization. Major complications related to embolization are reported in 5% of cases (EL4). The presence of coagulation disorders is not a contraindication to embolization (professional consensus). Embolization remains feasible after failed arterial ligations (selective or proximal) or after hysterectomy even if technically more challenging (professional consensus). Embolization can be performed in case of post partum hemorrhage related to abnormal placentation (professional consensus). Prophylactic embolization with the placenta left in place is not routinely recommended (professional consensus). The systematic preoperative placement of arterial occlusion balloons is not recommended in the management of abnormal placentation (professional consensus). Secondary post partum hemorrhage is a good indication for arterial embolization (grade C). After embolization, fertility can be spared (EL3). The risk of recurrent post partum hemorrhage does not seem different after arterial ligations or arterial embolization (EL3).
authors.affiliation: Service d'imagerie diagnostique et de radiologie thérapeutique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France. Electronic address: pelage-jp@chu-caen.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Pelage
authors.affiliation: Service d'imagerie diagnostique et de radiologie thérapeutique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Fohlen
authors.affiliation: Service d'imagerie diagnostique et de radiologie thérapeutique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: V
authors.initials: V
authors.lastname: Le Pennec
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D010922:Placenta Diseases / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D055988:Uterine Artery; D014593:Uterine Inertia / Q000628:therapy*
keywords: Artères iliaques internes (hypogastriques); Artères utérines; Atonie utérine; Embolisation; Embolization; Fertility after arterial embolization; Grossesse après embolisation pelvienne; Hémorragie du post-partum; Hémorragies du post-partum primaire; Hémorragies du post-partum secondaire; Internal iliac arteries (hypogastric); Placenta accreta; Placenta accrete; Post partum hemorrhage; Primary post partum hemorrhage; Secondary post partum hemorrhage; Thrombus vaginal; Uterine arteries; Uterine atony; Vaginal thrombus