Hypogastric Arterial Selective and Superselective Embolization for Severe Postpartum Hemorrhage: A Retrospective Review of 36 Cases

Abstract

We report on embolization in 36 cases of postpartum hemorrhage (PPH). The 36 patients with severe PPH, including one patient who had undergone an emergency hysterectomy, were transferred to the regional interventional vascular radiology unit in a mean time of 6 hours 12 min. Bilateral occlusion of the anterior trunk of the hypogastric arteries was carried out using gelatin sponge. Immediate success was achieved in all cases. In 3 cases, however, a second embolization was necessary before day 2. In 17%, complementary nonvascular surgery was performed. Complications included one puncture site false aneurysm treated by compression, two cases of regressive lower limb paraesthesia, one femoral vein thrombosis, and nonsignificant puncture site hematomas (19.5%). Long-term follow-up was conducted in 23 patients: 91% resumed regular menstrual cycles, 8.7% dysmenorrhea. New pregnancy occurred in 13% (two full-term pregnancies and one voluntary termination). Immediate efficacy, low morbidity and preservation of fertility make embolization the technique of choice for severe PPH.

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

“…Our study, which reports the largest number of pregnancies (n = 26) and full-term pregnancies (n = 19), confirms the results reported previously in the literature. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Contrary to our study, the majority of these case series, which have been published previously, did not use a systematic approach to follow-up and telephone contact with participants in an attempt to address subsequent fertility and obstetric outcome. Therefore, they did not 100 women eligible for inclusion in the study* 15 women encountered exclusion criteria peripartum hysterectomy (n = 9) performed before embolization (n = 2) after embolization (n = 7) embolization of vaginal arteries alone (n = 6) assess accurately the fertility outcome as they did not take into consideration the evaluation of desire and attempts to conceive.…”

“…8 Primary long-term studies suggest that uterine-sparing surgical procedures do not appear to impair subsequent fertility and pregnancy outcomes. [7][8][9][10] Previous studies of women undergoing embolisation have suggested that it does not impair subsequent fertility, [11][12][13][14][15][16][17][18][19][20][21][22][23][24] but the cohort, methodology and follow-up rate of these small case series are limited. 25 Moreover, in the majority of case series, no information is available regarding women with presumed preserved fertility and desire for pregnancy who do not become pregnant.…”

Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines

“…The menstrual cycle resumes in 91-100 % of patients who have undergone emergency TAE [1,11,15,17,20,[35][36][37][38][39]. Pregnancy can be expected in 69-100 % (average, 79 %) of women who desire future pregnancy [35].…”

“…Minor complications a. No need for specific therapy, no consequences [8,11,25,26]. Hematoma at the puncture site, arterial dissection (minor), post-embolization syndrome, embolization of non-targeted arteries such as ischemia of the lumber nerve plexus, allergy to local anesthetic (minor).…”

“…The gelatin sponge particle is the most common embolic agent [5,11,12]. The fine particle-like gelatin powder is not recommended because of the risk of adverse events associated with tissue ischemia, including the uterus and other pelvic organs, nerves, and the soft tissues [13,14].…”