Angiographic Embolization in the Treatment of Puerperal Hematoma

Abstract

Puerperal hematoma is one of the life threatening obstetrical emergencies. Surgical ligation of bleeding vessel may not always be possible for the patients who were hemodynamically unstable, hence pelvic arterial angiography may be preferred as the first line treatment modality for these cases. Pelvic arterial angiography and embolization is a safe, tolerable, and minimally invasive treatment modality in the diagnosis and treatment of pelvic hemorrhage. We present a case of puerperal hematoma after a normal spontaneous delivery treated with bilateral iliac arterial embolization.

Diagnosis and Management of Postpartum Retroperitoneal Hematoma: A Report of 3 Cases

“…Due to its greater safety index and precision, percutaneous artery embolization is the alternative choice to open surgery, provided the patient is hemodynamically stable [ 10 ]. The aims of percutaneous artery embolization, after identifying the bleeding vessel, are selective catheterization and embolization of the most distal artery possible [ 9 , 11 , 12 ]. These goals are not always achievable, however, and in certain circumstances, such as when there is no contrast extravasation in the angiography (due to intermittent bleeding, arterial spasticity, or vasoconstriction), bilateral embolization of the uterine arteries should be performed, because if it is performed unilaterally, repermeabilization can occur through collateral branches, thereby resulting in the reappearance of the bleeding [ 12 ].…”