Outcome of pelvic arterial embolization for postpartum hemorrhage: A retrospective review of 117 cases

Abstract

ObjectiveThe aim of this study was to evaluate indications, efficacy, and complications associated with pelvic arterial embolization (PAE) for postpartum hemorrhage (PPH).MethodsWe retrospectively reviewed the medical records of 117 consecutive patients who underwent PAE for PPH between January 2006 and June 2013.ResultsIn our single-center study, 117 women underwent PAE to control PPH refractory to conservative management including uterine massage, use of uterotonic agents, surgical repair of genital tract lacerations, and removal of retained placental tissues. Among 117 patients, 69 had a vaginal delivery and 48 had a Cesarean section. The major indication for embolization was uterine atony (54.7%). Other causes were low genital tract lacerations (21.4%) and abnormal placentation (14.5%). The procedure showed a clinical success rate of 88.0% with 14 cases of PAE failure; there were 4 hemostatic hysterectomies and 10 re-embolizations. On univariate analysis, PAE failure was associated with overt disseminated intravascular coagulation (P=0.009), transfusion of more than 10 red blood cell units (RBCUs, P=0.002) and embolization of both uterine and ovarian arteries (P=0.003). Multivariate analysis showed that PAE failure was only associated with transfusions of more than 10 RBCUs (odds ratio, 8.011; 95% confidence interval, 1.531-41.912; P=0.014) and embolization of both uterine and ovarian arteries (odds ratio, 20.472; 95% confidence interval, 2.715-154.365; P=0.003), which were not predictive factors, but rather, were the results of longer time for PAE. Three patients showed uterine necrosis and underwent hysterectomy.ConclusionPAE showed high success rates, mostly without procedure-related complications. Thus, it is a safe and effective adjunct or alternative to hemostatic hysterectomy, when primary management fails to control PPH.

Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications

“…Early reports with limited number of women have shown the potential of this technique that was later confirmed by larger studies [12][13][14][15][16][17][18][19]. Uterine atony accounts for the majority of causes of PPH and is the most common indication for TAE [20].…”

Hypogastric arteries ligation for the management of postpartum hemorrhage: a simple method of reducing uterine bleeding during surgery

“…When there is need of subsequent deliveries, the tendency is to choose a conservative surgical approach. This include uterine arteries ligation with or without ovarian arteries ligation 9 , B-Lynch suturing technique 8,9 , hypogastric arteries ligation (HAL) [10][11][12] and sometimes hypogastric arteries embolization [13,14].…”

Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review

“…These earlier studies were also limited by the larger number of predictive factors and the lack of multivariate analysis. (9,20) Cheong et al have recently suggested that the observed correlation between PAE failure and increased blood transfusion may be a result of longer procedure times for patients with clinical failure, rather than increased blood transfusion being a causative predictor of embolisation failure by itself. (20) In our study, which was performed in a regional acute general hospital setting, urgent PAE showed a success rate of over 70%, with no maternal deaths or complications.…”

“…(9,20) Cheong et al have recently suggested that the observed correlation between PAE failure and increased blood transfusion may be a result of longer procedure times for patients with clinical failure, rather than increased blood transfusion being a causative predictor of embolisation failure by itself. (20) In our study, which was performed in a regional acute general hospital setting, urgent PAE showed a success rate of over 70%, with no maternal deaths or complications. Follow-up of our post-PAE patients showed that all clinically successful patients had subsequent return of menstruation, except for the patient who had pre-embolisation hysterectomy.…”

“…There is very limited data available in the literature on the efficacy of repeat embolisation in patients with PPH. However, some of these studies document patients in whom repeat PAE has led to successful haemostasis (1,7,10,20) and patients with failed embolisation who require eventual surgery. Therefore, in patients with failed embolisation who are haemodynamically stable, repeat PAE should still be considered as a treatment option.…”