Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings

Abstract

BACKGROUND Transcatheter arterial embolization (TAE) has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management, but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage (PPH). AIM To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings. METHODS We conducted a research from January 2008 to July 2022 on all 83 patients (mean: 32 years, range: 24-43 years) presented with secondary PPH and they were treated with TAE in two university hospitals. The medical records and angiography were retrospective reviewed in order to evaluate the patients’ characteristics, delivery details, clinical status and peri-embolization management, angiography and embolization details, technical/clinical success and complications. The group with active bleeding sign and the group without it were also compared and analyzed. RESULTS On angiography, 46 (55.4%) patients showed active bleeding signs such as contrast extravasation ( n = 37) or pseudoaneurysm ( n = 8) or both ( n = 1), and 37 (44.6%) patients showed non-active bleeding signs such as only spastic uterine artery ( n = 2) or hyperemia ( n = 35). In the active bleeding sign group there were more multiparous patients, low platelet count, prothrombin time prolongation, and high transfusion requirements. The technical success rates were 97.8% (45/46) in active bleeding sign group and 91.9% (34/37) in non-active bleeding sign group, and the overall clinical success rates were 95.7% (44/46) and 97.3% (36/37). An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization, therefore hysterostomy and retained placenta removal were performed which was a major complication. CONCLUSION TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.