ABSTRACT
Treatment of obstetric hemorrhage by the selective embolization of damaged pelvic
vessels under fluoroscopy holds promise as an alternative to surgical intervention.
Unfortunately, the effectiveness of selective embolization is often compromised by
its use in emergent settings following the failure of primary operative approaches.
Therefore we compared the efficacy of prophylactic versus emergent catheter placement
for selective embolization in nine patients with or at risk for obstetric hemorrhage.
In four patients with acute obstetric hemorrhage catheterization and embolization
was carried out following the failure of initial medical and surgical approaches.
In five patients determined to be at risk for intrapartum hemorrhage based on sonographic
findings, catheters were inserted into the hypogastric vessels prior to elective cesarean
delivery. Three of these five patients subsequently required selective embolization.
In comparison to patients undergoing selective embolization following prophylactic
catheter placement, patients in the emergent group all had a coagulopathy at the time
of embolization, sustained substantially greater blood loss, and had an increased
rate of postpartum complications. Finally, there was a significant reduction in total
embolization time and therefore in radiation exposure in patients undergoing prophylactic
catheter placement prior to selective embolization. These data support the conclusion
that in patients determined to be at risk for intrapartum or postpartum hemorrhage
the prophylactic placement of catheters allows for selective embolization in a hemodynamically
intact patient with stable coagulation indices, theoretically reducing the risk of
maternal morbidity and possibly mortality.
