[Transcatheter arterial embolization in intractable postpartum hemorrhage]

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Obstetrics & Gynecology

Context:

• Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity and mortality worldwide.
• Conventional treatments for PPH, including pharmacotherapy and surgical interventions, are not always effective in severe cases.
• Refractory PPH necessitates advanced interventional techniques for hemorrhage control.

Purpose:

• To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for managing intractable postpartum hemorrhage.
• To assess the technical success rate and clinical outcomes of TAE in patients unresponsive to medical management.
• To determine the long-term effects of TAE on menstrual function and potential complications.

Summary:

• Fourteen patients with intractable PPH underwent TAE, with superselective catheterization of uterine arteries or anterior branches of internal iliac arteries.
• Digital subtraction angiography confirmed catheter placement, followed by antibiotic infusion and embolization with gelfoam particles.
• TAE was technically successful in all patients, achieving hemostasis within minutes and leading to normal menstrual cycles during follow-up (2-60 months) with no serious complications.

Impact:

• TAE offers a rapid and effective solution for life-threatening postpartum hemorrhage, reducing the need for hysterectomy.
• The procedure demonstrates a favorable safety profile with minimal complications, preserving fertility and reproductive potential.
• This interventional approach enhances the management armamentarium for obstetric emergencies, improving patient outcomes.