Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

The aim of this study was to evaluate the indications, efficacy, and safety of arterial catheterization and embolization for the management of emergent or anticipated massive obstetrical hemorrhage and its effects on menses and fertility.

Eighteen patients underwent arterial catheterization and embolization for intractable obstetrical hemorrhage between January 2001 and December 2005. Three groups of patients were identified: group 1 (n = 6) experienced postpartum hemorrhage; group 2 (n = 5) had anticipated severe postpartum hemorrhage; and group 3 (n = 7) had a risk factor for anticipated severe hemorrhage after dilation and evacuation. Gynecological information after embolization was obtained from medical records and telephone interviews.

All patients in group 1 had a favorable outcome after treatment with a single embolization. All patients in group 2 had a placenta previa with an estimated blood loss of 1215-3250 ml. In group 3, bleeding was controlled in six patients; one patient had a hysterectomy because embolization was not possible. There were no short-or long - term complications, and normal menstruation resumed. Four patients became pregnant after embolization.

Arterial catheterization and embolization is an effective, safe method for treating intractable obstetrical hemorrhage and might eliminate the need for hysterectomy and maintain reproductive ability.