title: Transcatheter arterial embolization as first-line rescue in intractable primary postpartum hemorrhage: Assessment, outcome, and subsequent fertility.
abstract: OBJECTIVE
  To assess the risk factors for intractable and controllable postpartum hemorrhage (PPH) and to evaluate the safety, efficacy, and outcome of transcatheter arterial embolization (TAE).
  
  
  METHODS
  An emergency PPH rescue system including the 24-hour-available TAE was established in 2004. TAE with gelatine sponge particles placed on bilateral uterine or internal iliac arteries served as the first-line treatment for intractable PPH. Delivery methods, parity, causes of bleeding, clinical vital signs, coagulopathy, success rate, resumption of menstruation, and subsequent pregnancy outcome after TAE were recorded.
  
  
  RESULTS
  From the years 2005 to 2013, 301 women experienced PPH, of whom 178 had controllable PPH and 123 intractable PPH. Tachycardia and disseminated intravascular coagulation were significant risk factors for intractable PPH. All of the women with intractable PPH underwent TAE, and 89 (72.3%) were transferred by ground transport to receive treatment in this system. The mean travel distance was 15 km ± 12.5 km. The mean time of order to angiography room was 24.9 minutes ± 14.2 minutes. The mean blood loss before TAE was 2247 mL ± 1482 mL (range, 900-11,110 mL). The first TAE successfully controlled bleeding in 118 of the 123 (95.9%) women with intractable PPH. Of the 70 women with complete follow-up, 69 (98.6%) recovered menstruation. Twenty-three women tried to get pregnant and 19 (82.6%) of them succeeded, giving birth to 12 full-term live infants.
  
  
  CONCLUSIONS
  TAE was safe and effective in treating intractable primary PPH with a high success rate and preservation of menstruation and fertility.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsin-Hsin
authors.initials: HH
authors.lastname: Cheng
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Leo Leung-Chit
authors.initials: LL
authors.lastname: Tsang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Te-Yao
authors.initials: TY
authors.lastname: Hsu
authors.affiliation: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chia-Te
authors.initials: CT
authors.lastname: Kung
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Ou
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ching-Di
authors.initials: CD
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: cheng.yufan@msa.hinet.net.
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: ftkung@cgmh.org.tw.
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005298:Fertility; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D010360:Patient Transfer; D006473:Postpartum Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055988:Uterine Artery / Q000503:physiopathology; D055357:Uterine Artery Embolization / Q000379:methods*
keywords: arterial embolization; fertility; menstruation; postpartum hemorrhage