European Radiology

, Volume 19, Issue 9, pp 2197–2203 | Cite as

Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

  • Yann Fargeaudou
  • Philippe SoyerEmail author
  • Olivier Morel
  • Marc Sirol
  • Olivier le Dref
  • Mourad Boudiaf
  • Henri Dahan
  • Roland Rymer


The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma.


Arterial embolization Arteries Postpartum hemorrhage Operative delivery Genital tract laceration Uterus Hemorrhage 


  1. 1.
    Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller FJ (1979) Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 54:361–365PubMedGoogle Scholar
  2. 2.
    Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M et al (1998) Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 208:359–362PubMedGoogle Scholar
  3. 3.
    Combs CA, Murphy EL, Laros RK Jr (1991) Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol 77:69–76PubMedGoogle Scholar
  4. 4.
    Yamashita Y, Takahashi M, Ito M, Okamura H (1991) Transcatheter arterial embolization in the management of postpartum hemorrhage due to genital tract injury. Obstet Gynecol 77:160–163PubMedGoogle Scholar
  5. 5.
    Hudelist G, Gelle’n J, Singer C et al (2005) Factors predicting severe perineal trauma during childbirth: Role of forceps delivery routinely combined with mediolateral episiotomy. Am Jour Obstet Gynecol 192:875–881CrossRefGoogle Scholar
  6. 6.
    Parikh R, Brotzman S, Anasti JN (2007) Cervical lacerations: some surprising facts. Am J Obstet Gynecol 196:17–18CrossRefGoogle Scholar
  7. 7.
    Biehl DR (1987) Antepartum and postpartum hemorrhage. In: Schnider SM, Levinson C (eds) Anesthesia for obstetrics, 2nd edn. Williams & Wilkins, Baltimore, MD, pp 385–394Google Scholar
  8. 8.
    Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N et al (2001) Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage ? AJR Am J Roentgenol 177:145–149PubMedGoogle Scholar
  9. 9.
    Lipshutz B (1918) A composite study of the hypogastric artery and its branches. Ann Surg 67:584–608PubMedCrossRefGoogle Scholar
  10. 10.
    Pelage JP, Le Dref O, Soyer P, Jacob D, Kardache M, Dahan H et al (1999) Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus. AJR Am J Roentgenol 172:989–994PubMedGoogle Scholar
  11. 11.
    Palacio Jaraquemada JM, Garcia Monaco R, Barbosa NE, Ferle L, Iriarte H, Conesa HA (2007) Lower uterine blood supply: extrauterine anastomotic system and its application in surgical devascularization techniques. Acta Obstet Gynecol Scand 86:228–234CrossRefGoogle Scholar
  12. 12.
    Kozak LJ, Weeks JD (2002) US trends in obstetric procedures, 1990-2000. Birth 29:157–161PubMedCrossRefGoogle Scholar
  13. 13.
    Vacca A (2007) Trials and tribulation of operative vaginal delivery. BJOG 114:519–521PubMedCrossRefGoogle Scholar
  14. 14.
    Caughey AB, Sandberg PL, Zlatnik MG, Thiet MP, Parer JT, Laros RK Jr (2005) Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstet Gynecol 106:908–912PubMedGoogle Scholar
  15. 15.
    Keriakos R, Mukhopadhyay A (2006) The use of the Rusch balloon for management of severe postpartum haemorrhage. J Obstet Gynaecol 26:335–338PubMedCrossRefGoogle Scholar
  16. 16.
    Lichtenberg ES (2003) Angiography as treatment for a high cervical tear: a case report. J Reprod Med 48:287–289PubMedGoogle Scholar
  17. 17.
    Murakami R, Ichikawa T, Kumazaki T, Kobayashi Y, Ogura J, Kurokawa A (2000) Transcatheter arterial embolization for postpartum massive hemorrhage: a case report. Clin Imaging 24:368–370PubMedCrossRefGoogle Scholar
  18. 18.
    Soyer P, Fargeaudou Y, Morel O, Boudiaf M, Le Dref O, Rymer R (2008) Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur Radiol 18:1181–1187PubMedCrossRefGoogle Scholar
  19. 19.
    Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, Frydman R, Fernandez H (2003) Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod 18:849–852CrossRefGoogle Scholar
  20. 20.
    Zahn CM, Hankins GD, Yeomans ER (1996) Vulvovaginal hematomas complicating delivery. Rationale for drainage of the hematoma cavity. J Reprod Med 41:569–574PubMedGoogle Scholar
  21. 21.
    Cottier JP, Fignon A, Tranquart F, Herbreteau D (2002) Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 100:1074–1077PubMedCrossRefGoogle Scholar
  22. 22.
    Albers L, Garcia J, Renfrew M, McCandlish R, Elbourne D (1999) Distribution of genital tract trauma in childbirth and related postnatal pain. Birth 26:11–17PubMedCrossRefGoogle Scholar
  23. 23.
    Hösli I, Tercanli S, Holzgreve W (2000) Complications of lost needle after suture of vaginal tear following delivery. Arch Gynecol Obstet 264:159–161PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Yann Fargeaudou
    • 1
  • Philippe Soyer
    • 1
    Email author
  • Olivier Morel
    • 2
  • Marc Sirol
    • 1
  • Olivier le Dref
    • 1
  • Mourad Boudiaf
    • 1
  • Henri Dahan
    • 1
  • Roland Rymer
    • 1
  1. 1.Department of Abdominal & Interventional ImagingHôpital Lariboisière-APHP-GHU Nord and Université Diderot-Paris 7Paris cedex 10France
  2. 2.Department of ObstetricsHôpital Lariboisière-APHP-GHU Nord and Université Diderot-Paris 7Paris cedex 10France

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