Outcomes of pelvic arterial embolization in the management of postpartum haemorrhage: a case series study and systematic review.
BACKGROUND
Postpartum haemorrhage (PPH) is an unpredictable obstetric emergency that requires a multidisciplinary approach. Pelvic arterial embolization (PAE) is considered as a second-line treatment, although the published results have not been reviewed systematically since 2007.


OBJECTIVE
To evaluate success and complication rates of PAE to treat PPH in the study hospital between 2009 and 2015, and to perform a systematic review of the literature on the reported efficacy and safety of PAE for the management of PPH.


METHODS
A systematic review of articles on PAE in English or Spanish was conducted using Medline and the Cochrane Library.


METHODS
All published articles assessing success and complication rates of PAE in cases of PPH. The search was restricted to articles published in English or Spanish between 2000 and 2015, with at least 25 cases.


METHODS
Obstetric variables, maternal haemodynamic state, pre-/postembolization management, technique-related variables, post-PAE evolution and complications were recorded in the case series study. Study characteristics, success rates and PAE-related complication rates were recorded in the systematic review.


RESULTS
The case series included 29 patients. The majority of these patients were primiparous, with singleton term pregnancies and spontaneous labour. Caesarean section was performed in 62.1% of patients undergoing PAE for PPH. PAE was successful in 89.6% [95% confidence interval (CI) 78.3-100] of cases. Twenty studies were included in the systematic review, providing data from 1739 patients. PAE was successful in 89.4% (95% CI 87.9-90.9) of cases. The mortality rate was 0.9%, and other major complications were uncommon (1.8%).


CONCLUSIONS
PAE was found to be a minimally invasive, highly successful and safe technique for the management of PPH. It should be considered in PPH refractory to initial treatment.
Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
F J
FJ
Ruiz Labarta
Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
M P
MP
Pintado Recarte
Department of Radiology, Division of Interventional Radiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
A
A
Alvarez Luque
Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
L
L
Joigneau Prieto
Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
L
L
Perez Martín
Department of Radiology, Division of Interventional Radiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
M
M
Gonzalez Leyte
Department of Anaesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
F
F
Palacio Abizanda
Department of Anaesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
F
F
Morillas Ramirez
Department of Haematology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
A
A
Perez Corral
Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
L
L
Ortiz Quintana
Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: jdeleonluis@yahoo.es.
J
J
De Leon-Luis
D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D010388:Pelvis / Q000098:blood supply*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D016896:Treatment Outcome
Complication; Pelvic arterial embolization; Postpartum haemorrhage; Success rate; Systematic review; Uterine atony