Arterial embolisation for persistent primary postpartum haemorrhage: before or after hysterectomy?

Arterial embolisation is a recognised treatment for postpartum haemorrhage (PPH). In this retrospective study, we evaluate its use in the management of persistent PPH. Records of all births during a 54 month period at a university hospital were analysed. Two sub-groups were identified. Group I (n= 5), underwent embolisation after hysterectomy and Group II (n= 4), had embolisation as a first-line theraphy without hysterectomy. Of 20,215 births, there were 636 cases of PPH (3.1%). Nine required embolisation to control bleeding (1.4%). Group I needed multiple surgical procedures, had a larger pre- and post-operative blood requirement (12-100, median 22 units, vs. 6-12, median 8.5 units), longer embolisation (33-93, median 54 minutes, vs 20-66, 47 minutes) with a larger radiation exposure (5194-9067, median 6301 dGy, vs. 269-3862, median 950 dGy), a longer intensive care stay (3-7, median four days vs. 0-1.5, median one day), and more complications, when compared with Group II. Three of four women from Group II resumed menstrual function. Embolisation prior to hysterectomy may be preferable to embolisation after hysterectomy for the control of PPH.