Secondary postpartum hemorrhage: Treatment with selective arterial embolization

PURPOSE: To evaluate the efficacy and safety of selective arterial emboliza tion of the uterine arteries in the management of intractable delayed postp artum hemorrhage. MATERIALS ANP METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arterie s. In all cases, hemostatic embolization was performed because of intractab le hemorrhage that could not be controlled with the administration of utero tonic drugs or with uterine curettage. RESULTS: The cases of bleeding included genital tract tears in four women a nd endometritis in eight women; the endometritis was associated with proved , retained portions of placenta in four women. In two women, no evident cau se of bleeding was found before angiography. Angiography revealed extravasa tion in three women. A false aneurysm of the uterine artery was found in tw o women. In one patient, an arteriovenous fistula was observed. Immediate r esolution of external bleeding was observed in all women. No complication r elated to embolization was found. Normal menstruation resumed in all women. CONCLUSION: Selective arterial embolization of the uterine arteries is a sa fe and effective means of controlling secondary postpartum hemorrhage.