Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases
To evaluate pelvic artery embolisation (PAE) in the emergency management of intractable postpartum haemorrhage (PPH) associated with placenta accreta (PA).
Forty such patients (PAE for PPH/PA) were retrospectively reviewed. Medical records were reviewed regarding the delivery and PAE procedure. Follow-up gynaecological outcomes after PAE were obtained by telephone interviews.
Technical success was achieved in all women (100 %). The initial clinical success rate was 82.5 % (33/40). Three patients with PA underwent hysterectomy after PAE failed to stop the bleeding within 24 h after the embolisation. The other three patients underwent re-embolisation (two patients underwent re-embolisation on the next day and one patient had undergone re-embolisation 6 h after the first embolisation), and bleeding had stopped eventually. The clinical success rate was 92.5 %. There were four cases of immediate complications, such as, pelvic pain, nausea and urticaria. There were three late minor complications, temporary menopause, but no late major complications. After the procedure, 35 patients resumed normal menstruation, including two uncomplicated pregnancies. One patient expired owing to disseminated intravascular coagulopathy and intracerebral haemorrhage, despite successful embolisation.
PAE can be performed safely and effectively for patients with PPH and PA and can preserve the uterus in many patients.
• Pelvic artery embolisation (PAE) is an important therapeutic option for postpartum haemorrhage.
• It seems safe and effective for PPH with placenta accreta (PA).
• PAE preserves the uterus and does not impair subsequent menstruation.
• PAE has few major complications.
KeywordsPostpartum haemorrhage Embolisation Placenta abnormality Preservation of fertility Complication
The authors would like to thank the medical staff at all the departments visited for their cooperation in the data collection for the study.
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