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European Radiology

, Volume 20, Issue 7, pp 1777–1785 | Cite as

Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation

  • Yann FargeaudouEmail author
  • Olivier Morel
  • Philippe Soyer
  • Etienne Gayat
  • Marc Sirol
  • Mourad Boudiaf
  • Henri Dahan
  • Emmanuel Barranger
  • Alexandre Mebazaa
  • Olivier le Dref
Interventional

Abstract

Objectives

To evaluate the role and efficacy of pelvic embolisation in the treatment of persistent postpartum haemorrhage after failed arterial ligation and to identify the complications of this procedure in this specific population.

Methods

The clinical files and angiographic examinations of 12 consecutive women (mean age 32 years) who were treated with pelvic embolisation because of persistent, severe postpartum haemorrhage after failed arterial ligation were reviewed.

Results

Angiography revealed that persistent bleeding was due to incomplete arterial ligation (n = 4) or the presence of newly developed anastomotic routes (n = 8). In 11 women, pelvic embolisation stopped the bleeding. Hysterectomy was needed in one woman with retained placenta. Two complications due to pelvic embolisation, including leg ischaemia and transient sciatic nerve ischaemia, were identified, both after internal iliac artery ligation.

Conclusions

In women with persistent postpartum haemorrhage after failed arterial ligation, pelvic embolisation is an effective treatment in most cases. However, embolisation of the anastomotic routes that contribute to persistent bleeding may result in ischaemic complications. These potential complications reaffirm that arterial ligation should not be the favoured option for postpartum haemorrhage and that special care must be given during pelvic embolisation after failed arterial ligation.

Keywords

Postpartum haemorrhage Percutaneous transcatheter arterial embolisation Pelvic embolisation Internal iliac artery Arterial ligation Abnormal placentation 

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Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Yann Fargeaudou
    • 1
    Email author
  • Olivier Morel
    • 2
  • Philippe Soyer
    • 1
  • Etienne Gayat
    • 3
  • Marc Sirol
    • 1
  • Mourad Boudiaf
    • 1
  • Henri Dahan
    • 1
  • Emmanuel Barranger
    • 2
  • Alexandre Mebazaa
    • 3
  • Olivier le Dref
    • 1
  1. 1.Department of Abdominal and Interventional ImagingHôpital Lariboisière AP-HP and Université Diderot-Paris 7ParisFrance
  2. 2.Department of Obstetrics and GynecologyHôpital Lariboisière AP-HPParisFrance
  3. 3.Department of Anesthesiology and Intensive Care MedicineHôpital Lariboisière AP-HPParisFrance

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