Endovascular treatment of obstetric hemorrhage

Czech version

Authors: A. Krajina ¹; I. Kalousek ²; Miroslav Lojík ¹ ; V. Chovanec ¹; J. Raupach ¹; J. Grepl ¹; O. Renc ¹; V. Řeháček ³; Eva Čermáková ⁴
Authors‘ workplace: Radiologická klinika LF a FN, Hradec Králové, přednosta prof. MUDr. P. Eliáš, CSc. ¹; Porodnická a gynekologická klinika LF a FN, Hradec Králové, přednosta doc. MUDr. J. Tošner, CSc. ²; Transfuzní oddělení LF a FN, Hradec Králové, primář MUDr. V. Řeháček ³; Oddělení výpočetní techniky LF UK, Hradec Králové, RNDr. E. Čermáková ⁴
Published in: Ceska Gynekol 2012; 77(6): 588-594

Overview

Purpose:
To evaluate effectiveness and safety of hypogastric artery branches embolization in the treatment of postpartum hemorrhage, hemorrhage associated with cesarean section and termination of pregnancy.

Materials and methods:
All women with intractable bleeding and who were treated by embolization, were included from the period between 1996 to 2010. The retrospective study included 16 women of mean age 30.5 years.

Results:
Intractable hemorrhage related to regular delivery occurred 7 times, five times after cesarean section and four times after termination of pregnancy. Seven women (44%) were in hemorrhagic shock during therapeutic embolization. Extravazation was angiographically proved in 50% cases. Embolization was successful in hemorrhage control in 87,5% of women, in two women embolization was repeated for persistent bleeding. There were 21 additional surgical procedures performed in 13 women before embolization including 2 hysterectomies. Two hysterectomies were done after embolization because of infection. In remaining 3 women embolization was done as a primary method of bleeding control. No patient died. In the group of 10 women with maximally 1 surgery before embolization length of hospital stay was 10.1 days in average, while in a group of six women having 2 to 3 surgeries before embolization the hospital stay was 21.2 days in average (p = 0.03).

Conclusion:
Embolization of hypogastric arteries decreases length of hospital stay in patients with obstetric hemorrhage and should be done soon if routine methods of bleeding control fail.

Key words:
postpartum hemorrhage, angiographic selective embolization, uterine artery embolization.

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