Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage; Two Centers' Experience in 100 Patients

Abstract

Postpartum hemorrhage is a major cause of maternal mortality all over the world and in Arab world as well. Uterine artery embolization (UAE) could be very effective if local measures failed to stop bleeding. Methods: In the participated two centers, 100 women (mean age 29 years) with postpartum hemorrhage underwent transarterial embolization in Ain Shams University and Sheikh Khalifa Ben Zayed Hospitals after failure to achieve hemostasis after conservative treatments. Clinical success was defined as stabilization of vital data of the patient and obviation of hysterectomy. Gelatin sponge particles were used as embolic agent in all the patients. Results: Bleeder could be identified angiographically in 86 patients (pseudoaneurysm in 6 patients and extravasation from birth canal laceration in 80 patients). In 16 patients, no definite bleeder could be identified, so bilateral uterine artery embolization was done empirically. Clinical success rate was 90% (92 patients including all patients with angiographically identified bleeder). Re-embolization was done in eight patients. Hysterectomy was needed in four patients: two after rebleeding after the second UAE and two after first UAE. No major procedural-related complications were recorded. Conclusion: In this large number of cases, transcatheter embolization of the uterine artery is a feasible treatment option in management of postpartum bleeding with low rates of complications. Angiographic identification of the bleeding source was associated with higher clinical success rates decreasing the need for hysterectomies.