Pelvic arterial embolization for control of obstetric hemorrhage: A five-year experience

OBJECTIVE: Obstetric hemorrhage is a significant cause of maternal morbidit y and death. Postpartum hemorrhage that cannot be controlled by local measu res has traditionally been managed by bilateral uterine artery or hypogastr ic artery ligation. These techniques have a high failure rate, often result ing in hysterectomy. In contrast, endovascular embolization techniques have a success rate of >90%. An additional benefit of the latter procedure is t hat fertility is maintained. We report our experience at Stanford Universit y Medical Center in which this technique was used in 6 cases within the pas t 5 years. STUDY DESIGN: Six women between the ages of 18 and 41 years underwent place ment of arterial catheters for emergency (n = 3) or prophylactic (n = 3) co ntrol of postpartum bleeding. Specific diagnoses included cervical pregnanc y (n = 1), uterine atony (n = 3), and placenta previa and accreta (n = 2). RESULTS: Control of severe or anticipated postpartum hemorrhage was obtaine d with transcatheter embolization in 4 patients. A fifth patient had balloo n occlusion of the uterine artery performed prophylactically, but embolizat ion was not necessary. In a sixth case, bleeding could not be controlled in time, and hysterectomy was performed. The only complication observed with this technique was postpartum fever in 1 patient, which was treated with an tibiotics and resolved within 7 days. CONCLUSIONS: Uterine artery embolization is a superior first-line alternati ve to surgery for control of obstetric hemorrhage. Use of transcatheter occ lusion balloons before embolization allows timely control of bleeding and p ermits complete embolization of the uterine arteries and hemostasis. Given the improved ultrasonography techniques, diagnosis of some potential high-r isk conditions for postpartum hemorrhage, such as placenta previa or accret a, can be made prenatally. The patient can then be prepared with prophylact ic placement of arterial catheters, and rapid occlusion of these vessels ca n be achieved ii necessary.