Selective Uterine Artery Embolization in Postpartum Hemorrhage; Updates on 5 Years' Single-Center Experience

Objectives: Postpartum uterine hemorrhage is one of the most important causes of maternal mortality worldwide and as well in Egypt. Causes are variable, the most important of which are uterine atony and birth canal lacerations. Uterine artery embolization (UAE) is very effective if local measures failed to stop bleeding. Methods: In the period between January 2015 and December 2019, 200 women (mean age 26 years) with postpartum hemorrhage underwent embolization in Ain Shams University 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. Gel foam hand-cut pledges were the embolic agents used. Results: Bleeder whether extravasation or pseudoaneurysm could be identified angiographically in 120 patients. In 80 patients, no definite bleeder or just diffuse hyperema could be identified, so bilateral UAE was done empirically. Clinical success rate was 85% (170 patients including 117 patients with angiographically identified bleeder). Hysterectomy was needed in 30 patients after rebleeding post-UAE. No major procedural-related complications were recorded. Conclusion: Transcatheter arterial 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.

 

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Publication History

Article published online:
26 April 2021