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Severe secondary postpartum haemorrhage after caesarean section.
P M Shweni1, B B Bishop, J N Hansen
1Department of Obstetrics and Gynaecology, University of Natal.
Summary
Severe postpartum hemorrhage after cesarean delivery can be treated with selective transcatheter embolization. This minimally invasive procedure offers a viable alternative to hysterectomy for managing this critical obstetric complication.
Area of Science:
- Obstetrics and Gynecology
- Vascular Interventional Radiology
Background:
- Secondary postpartum hemorrhage following cesarean section is a rare but serious complication.
- Delayed bleeding, occurring weeks after delivery, presents unique management challenges.
Purpose of the Study:
- To evaluate the efficacy of selective transcatheter embolization in managing severe secondary postpartum hemorrhage after cesarean delivery.
Main Methods:
- Retrospective review of 13 patients with severe secondary postpartum hemorrhage.
- Comparison of surgical management (hysterectomy, uterine wound revision) with transcatheter arterial embolization using Gelfoam pledgets.
Main Results:
- Eight patients underwent hysterectomy, and one had uterine wound revision and vessel ligation.
- Selective transcatheter embolization was used in four patients, achieving successful hemostasis in three (75% success rate).
- No maternal deaths were reported in the study cohort.
Conclusions:
- Selective transcatheter embolization is a promising, less invasive treatment option for severe secondary postpartum hemorrhage after cesarean section.
- Embolization should be considered as a potential alternative to hysterectomy in select cases.