J Korean Radiol Soc.  2008 Dec;59(6):373-379. 10.3348/jkrs.2008.59.6.373.

Intractable Postpartum Bleeding: A Comparison of the Retrospective Analysis of Angiographic Findings and Transcatheter Arterial Embolization According to Delivery Pattern

• Ahn EJ
• Kim YH
• Kim SH
• Choi JS
• Park JC
• Kwon SH
• Jo CH
• Cha SD

• KMID: 2103924
• DOI: http://doi.org/10.3348/jkrs.2008.59.6.373

Abstract

PURPOSE
We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern.
MATERIALS AND METHODS
Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility.
RESULTS
Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant.
CONCLUSION
Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.

Keyword

Uterus; Embolization, therapeutic; Postpartum hemorrhage; Obstetric labor complications; Angiography

MeSH Terms

Adhesives
Angiography
Cesarean Section
Embolization, Therapeutic
Female
Fertility
Gelatin Sponge, Absorbable
Hemorrhage
Humans
Infant
Interviews as Topic
Medical Records
Menstruation
Obstetric Labor Complications
Postpartum Hemorrhage
Postpartum Period
Pregnancy
Retrospective Studies
Uterus
Adhesives