LIFE-THREATENING PRIMARY POSTPARTUM HEMORRHAGE - TREATMENT WITH EMERGENCY SELECTIVE ARTERIAL EMBOLIZATION

PURPOSE: To prospectively evaluate the efficacy and safety of emergenc y selective arterial embolization in the management of intractable pri mary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consec utively seen women with life-threatening primary postpartum hemorrhage underwent uterine embolization. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be con trolled with vaginal packing and administration of uterotonic drugs. T he mean hemoglobin level before embolization was 7.48 g/dL +/- 2.39 (7 4.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in tw o patients before embolization failed to stop the bleeding. RESULTS: A ngiography revealed extravasation in nine patients arid spasm of the b ranches the internal iliac artery in five. The procedure consisted of embolization of uterine (n = 46), vaginal (n = 5), or ovarian(n = 2) a rteries or anterior division of internal iliac arteries (n = 8). Immed iate disappearance or dramatic diminution of external bleeding was obs erved in all cases. Two patients needed repeated embolization the next day. No major complication related to embolization was found.ln one p atient with placenta accreta, delayed hysterectomy was necessary. Norm al menstruation resumed in all women except the two who underwent hyst erectomy. One woman became pregnant after embolization. CONCLUSION: Em ergency arterial embolization is a safe and effective means of control of primary postpartum hemorrhage. The procedure obviates high-risk su rgery and allows maintenance of reproductive ability.