Interventional Management of Postpartum Hemorrhage

Embolization of the inferior mesenteric artery for post‐partum hemorrhage with a vaginal laceration: A case with unusual collateral supply

“…5 A rare anatomic variant of the uterine artery arising from the IMA has also been reported in the literature. 6 Only one case in a patient with a condition not associated with uterine fibroids or an anatomical variant of uterine artery was reported in 2015 on PPH originating from the distal IMA by Shin et al 7 In our case, one of the origins of PPH was confirmed from the distal branch of the IMA. In both initial and follow-up aortogram, the contrast extravasation on the right side of the pubic joint around the vagina was seen.…”

“…A few reports indicate that the IMA branch produces collaterals to the uterus in patients with uterine leiomyomas, adenomyosis, or a history of uterine artery ligation or uterine artery embolization . A rare anatomic variant of the uterine artery arising from the IMA has also been reported in the literature . Only one case in a patient with a condition not associated with uterine fibroids or an anatomical variant of uterine artery was reported in 2015 on PPH originating from the distal IMA by Shin et al …”

Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage

“…Upon delivery, contraction of the myometrium compresses the spiral arteries, leading to hemostasis. 18,24 The most common cause of PPH is failure of mechanical compression of the spiral arteries caused by uterine atony. 24 Uterine atony accounts for 70% of cases of primary PPH and often results in hemorrhagic shock, which can progress to endothelial damage and DIC.…”

“…18,24 The most common cause of PPH is failure of mechanical compression of the spiral arteries caused by uterine atony. 24 Uterine atony accounts for 70% of cases of primary PPH and often results in hemorrhagic shock, which can progress to endothelial damage and DIC. 25,26 Additional causes of PPH include retained products of conception, abnormally invasive placenta (AIP; placenta accreta/increta/percreta spectrum), uterine rupture, lower genital tract laceration, and coagulopathy.…”

“…The spiral arteries arise from the radial arteries, and project into the endometrium. 24 Anatomic variants of the uterine artery origin are common. A rich collateral supply exists in the female pelvis.…”