Limits of arterial embolization in the management of serious postpartum haemorrhage.

Objective: To assess the limits of arterial embolization in the management of serious postpartum haemorrhage (PPH). Study design: Retrospective study. Patients and methods: We examined the cases of 29 patients admitted to inte nsive care units of Rouen University Hospital for PPH between January 1994 and August 1999. Demographic, obstetrical and biological data, the required treatment and eventual side effects were collected and analysed using the appropriate parametric and non parametric tests. Results: Arterial embolization was carried out on 15 patients (52%) with a success rate of 73%. Of the 14 other patients, 11 underwent conservative or radical surgery without further complications, three received medical trea tment. No maternal death occurred; however, one patient transferred from a local hospital and already presenting haemodynamic instability suffered car diac arrest before embolization. Arterial embolization was unsuccessful in four cases, two of which were cases of placenta accreta. These patients wer e older (p < 0.05) and all had a past history of curettage and/or caesarean section for preceding deliveries (P < 0.01). Conclusions: Emergency arterial embolization is a valuable therapy in case of PPH but can only be carried out in specialised units. Obstetrical antece dents would appear to constitute a major risk factor and transfer increases the morbidity rate. (C) 2001 Editions scientifiques et medicales Elsevier SAS.