title: Pelvic Artery Embolization in the Management of Obstetrical Hemorrhage: Predictive Factors for Clinical Outcomes.
abstract: OBJECTIVE
  To evaluate clinical outcomes of pelvic artery embolization (PAE) for treatment of obstetric hemorrhage, and determine the predictive factors associated with failure.
  
  
  METHODS
  This retrospective study included all consecutive patients who underwent PAE for obstetric hemorrhage (not only in the post-partum setting), between January 2003 and January 2013 at three tertiary care centers. Medical records and imaging were reviewed to identify the study population and collect data on patient characteristics, PAE characteristics, and outcomes. Multiple parameters were compared between the failed and successful PAE groups, and univariate analysis was performed to determine the predictive factors for PAE failure.
  
  
  RESULTS
  A total of 74 PAE procedures were performed in 68 patients. Primary clinical success rate was 78%. On univariate analysis, three factors were associated with PAE failure: hemodynamic instability (p < 0.022), hemoglobin level <95 g/dL (p < 0.024), and disseminated intravascular coagulation (DIC) (p < 0.046). Other factors, including maternal characteristics, antecedent history, angiographic finding, embolic agent, operator experience, procedure done after hours, and unilateral versus bilateral embolization, did not show any statistically significant association with PAE failure. Only one major complication was encountered, which was fetal demise in a pregnant patient with a uterine arteriovenous malformations. Out of the 68 patients, there were 61 total pregnancies at follow-up.
  
  
  CONCLUSIONS
  PAE is an effective treatment for obstetric hemorrhage, with a low complication rate, and preserves fertility. Factors significantly associated with PAE failure include hemodynamic instability, hemoglobin level <95 g/dL, and DIC.
authors: Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada. ezhang@ualberta.ca.
authors: E
authors: E
authors: Zhang
authors: Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada. lizhi.liu@usask.ca.
authors: L
authors: L
authors: Liu
authors: Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada. rowen@ualberta.ca.
authors: R
authors: R
authors: Owen
mesh_terms: D000293:Adolescent; D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D010388:Pelvis / Q000098:blood supply* / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055988:Uterine Artery / Q000000981:diagnostic imaging; D014592:Uterine Hemorrhage / Q000628:therapy*; D055815:Young Adult
keywords: Clinical outcomes; Fertility; Obstetric hemorrhage; Pelvic artery embolization; Post-partum hemorrhage; Predictive factors for failure; Uterine artery embolization