Endovascular treatment of obstetric hemorrhage

Authors: A. Krajina 1;  I. Kalousek 2;  M. Lojík 1;  V. Chovanec 1;  J. Raupach 1;  J. Grepl 1;  O. Renc 1;  V. Řeháček 3;  E. 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: Čes. Gynek.2012, 77, č. 6 s. 588-594


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.

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).

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.


1. Bros, S., Chrabrot, P., Kastle, A., et al. Recurrent bleeding within 24 hours after uterine artery embolization for severe postpartum hemorrhage: are there predictive factors? Cardiovasc Intervent Radiol, 2012, 35, p. 508–514.

2. Bodner, LJ., Nosher, JL., Gribbin, CH., et al. Balloon-assisted occlusion of the internal iliac arteries in patiens with placenta accreta/percreta. Cardiovasc Intervent Radiol, 2006, 29, p. 354–361.

3. Boulleret, C., Chahid, T., Gallot, D., et al. Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Interv Radiol, 2004, 27, p. 344–348.

4. Braf, ZF., Koontz WW. Jr. Gangrene of bladder complication of hypogastric artery embolization. Urology, 1977, 9, p. 670–671.

5. Brown, BJ., Henston, DK., Poulson, AM., et al. Uncontrollable post-partum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol, 1979, 54, p. 361–365.

6. Karnevale, FC., Kondo, MM., de Oliveira Sousa W. Jr., et al. Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhagie in placenta accreta. Cardiovasc Intervent Radiol, 2011, 34, p. 758–764.

7. Chou, MM., Hwang, JI., Tseng, JJ., Ho, ESC. Internal iliac artery embolization before hysterectomy for placenta accreta. J Vasc Interv Radiol, 2003, 14, p. 1195–1199.

8. Deux, JF., Bazo, M., Le Blance, AF., et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? Am J Roentgenol, 2001, 177, p. 145–149.

9. Diop, AN., Chrabrot, P., Bertrand, A., et al. Placenta accreta: management with sterine artery embolization in 17 cases. J Vasc Interv Radiol, 2010, 21, p. 644–648.

10. Finnegan, MF., Tisnado, J., Bezirdjian, DR., Cho, SR. Transcatheter embolotherapy of massive bleeding after surgery for benign gynecologic disorders. J Can Assoc Radiol, 1988, 39, p. 172–177.

11. Ganguli, S., Stecker, MS., Pyne, D., et al. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol, 2011, 22, p. 169–176.

12. Hare, WSC., Holland, CJ. Paresis following internal iliac artery embolization. Radiology, 1983, 146, p. 47–51.

13. Hlava, A., Krajina, A., Niangová, I. Embolizace vnitřních pánevních tepen při krvácení. In Hlava, A., Krajina, A. Intervenční radiologie. Hradec Králové: Nukleus, 1996, s. 344–350.

14. Hong, TM., Tseng, HS., Lee, RC., et al. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol, 2004, 59, p. 96–101.

15. Hsu, S., Rodgers, B., Lele, A., Yeh, J. Use of packing in obstetric hemorrhage of uterine origin. J Reprod Med, 2003, 48, 2, p. 69–71.

16. Karpati, P., Rossignol, M., Pirot, M., et al. High incidence of myocardial ischemia during postpartum hemorrhage. Anestesiology, 2004, 100, 1, p. 30–36.

17. Kidney, DD., Nguyen, AM., Ahdoot, D., et al. Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation. Am J Roentgenol, 2001, 176, p. 1521–1524.

18. Lédée, N., Ville, Y., Muset, D., et al. Management in intractable obstetric haemorrhage: an audit study on 61 cases. J Gyn Obstet Biol, 2001, 94, p. 189–196.

19. Lim, AKP., Agarwal, R., Seckl, MJ., et al. Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors. Radiology, 2002, 222, p. 640–644.

20. Mariano, RT, Stein, B, Vine, HS, et al. Angiographic diagnosis and transarterial embolization of iatrogenic ovarian artery injury.J Vasc Interv Radiol, 2000, 11, p. 625–628.

21. Mitty, HA., Sterling, KM., Alvarez, M., Gendler, R. Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology, 1993, 188, p. 183–187.

22. Naydich, M., Friedman, A., Aaron, G., Silberzweig, J. Arterial embolization of vaginal arterial branches for severe postpartum hemorrhagie despite hysterectomy. J Vasc Interv Radiol, 2007, 18, p. 1047–1050.

23. Pelage, JP., Le Dref, O., Mateo, J., et al. Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology, 1998, 208, 2, p. 359–362.

24. Pelage, JP., Soyer, P., Repiquet, D., et al. Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology, 1999, 212, p. 385–389.

25. Salomon, LJ., deTayrac, R., Castaigne-Meary, V., et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod, 2003, 18, 4, p. 849–852.

26. Stancato-Pasik, A., Mitty, HA., Richard III, HM., Eshkar, N. Obstetric embolotherapy: effect on menses and pregnancy. Radiology, 1997, 204, p. 791–793.

27. Thon, S., Mclintic, A., Wagner, Y. Prophylatic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series. Int J Obstet Anesth, 2011, 20, p. 64–88.

28. Walker, WJ. Case report: successful internal iliac artery embolisation with glue in a case of massive obstetric haemorrhage. Clin Radiol, 1996, 51, p. 442–444.

29. Weeks, SM., Stroud, TH., Sandhu, J., et al. Temporary balloon occlusion of the internal iliac arteries for control of hemorrhage during cesarean hysterectomy in a patient with placenta previa and placenta increta. J Vasc Interv Radiol, 2000, 11, p. 622–624.

30. Yamashita, Y., Takahashi, M., Ito, M., Okanuta, H. Transcatheter arterial embolization in the management of postpartum hemorrhage due to genital tract injury. Obstet Gynecol, 1991, 77, p. 160–163.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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