[Interventional radiology in managing post-partum hemorrhage].

Area of Science:

• Interventional Radiology
• Obstetrics & Gynecology
• Vascular Surgery

Background:

• Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide.
• Uterine artery embolization (UAE) is increasingly recognized as a vital intervention for managing severe PPH.
• Prompt and effective management is critical to prevent life-threatening complications.

Purpose of the Study:

• To evaluate the efficacy and safety of UAE as a primary treatment for PPH.
• To define the optimal multidisciplinary approach for patient selection and management.
• To identify factors influencing treatment success and potential complications.

Main Methods:

• UAE involves transcatheter arterial embolization of the uterine arteries.
• Procedure performed under local anesthesia with femoral artery access.
• Bilateral embolization using gelatin particles is the standard technique.
• Angiographic assessment of pelvic vasculature precedes embolization.

Main Results:

• UAE demonstrates high efficacy in controlling PPH due to uterine atonia.
• Success rates are lower for PPH caused by cervical-vaginal lacerations or placenta accreta.
• Complications in patients with healthy arteries are exceptionally rare.
• Multidisciplinary team decision-making is essential for optimal outcomes.

Conclusions:

• UAE is a highly effective and minimally invasive option for PPH management, especially uterine atonia.
• Access to 24/7 UAE services and experienced multidisciplinary teams is crucial.
• Patient transport for uncontrolled hemorrhage poses significant risks.
• While generally safe, careful patient selection is necessary for cases involving abnormal placental insertion or cervical tears.