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Efficacy of pelvic artery embolisation for severe postpartum hemorrhage

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of our study was to evaluate the outcome of selective pelvic arterial embolisation (PAE) in women with severe postpartum hemorrhage (PPH).

Methods

We performed a retrospective, controlled, single-center cohort study. A total of 16 consecutive women with PPH who underwent therapeutic PAE were included. As historical control group, we included 22 women with similar severity of PPH who were managed without PAE. Outcome measures included necessity of surgical interventions such as postpartum hysterectomy and laparotomy after vaginal delivery, the amount of red blood cell transfusions, and hematologic findings after the procedure.

Results

PAE was successful in stopping PPH and preserving the uterus in all 16 women in the study group. No woman in the PAE group required a postpartum hysterectomy, whereas postpartum hysterectomy was unavoidable in two women in the control group. Laparotomy after vaginal delivery was necessary in two women of the group without embolisation. Hematologic parameters after the treatment were better in the PAE group than in the control group, although these differences were only in part statistically significant. There were no unwarranted effects of PAE identifiable in the study group.

Conclusion

This is the first controlled study assessing the efficacy of PAE for the treatment of PPH. Our data suggest that PAE is effective for the treatment of severe PPH. In view of the lack of complications and unwarranted effects, clinical use of PAE in severe PPH seems justified, particularly in view of the life-threatening condition and the potential to preserve fertility in affected patients. Further evidence from well-designed prospective randomized-controlled trials would be nevertheless desirable in the future.

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Abbreviations

DIC:

Disseminated intravascular coagulation

FFP:

Fresh frozen plasma

PAE:

Selective pelvic arterial embolisation

PLT:

Platelets

PPH:

Severe postpartum hemorrhage

RBCU:

Red blood cell unit

RCOG:

Royal College of Obstetricians and Gynaecologists

rhFVIIa:

Recombinant human factor VIIa

SEM:

Standard error of the mean

UBT:

Uterine balloon tamponade

WHO:

World Health Organization

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland

    Annette Spreu, F. Abgottspon, M. U. Baumann & D. Surbek

  2. Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland

    J. Kettenbach

Authors
  1. Annette Spreu
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  2. F. Abgottspon
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  3. M. U. Baumann
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  4. J. Kettenbach
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  5. D. Surbek
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Contributions

All persons who meet authorship criteria are listed as authors, and all authors have participated sufficiently in the work to take public responsibility for the content. AS: Data analysis, Manuscript writing, Manuscript editing. FA: Data collection, Manuscript writing. MUB: Data analysis. JK: Manuscript reviewing. DS: Project Development, Manuscript reviewing.

Corresponding author

Correspondence to Annette Spreu.

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Conflict of interest

All authors declare no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Ethical approval

This study has been approved by the ethical committee of the canton of Bern, Switzerland. Date of ethics approval: 13.06.2016. Reference number to the ethics approval statement: 3037. The ethical committee decided that no consent for participation was necessary because the study was retrospective. The ethic approval is attached herewith.

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Spreu, A., Abgottspon, F., Baumann, M.U. et al. Efficacy of pelvic artery embolisation for severe postpartum hemorrhage. Arch Gynecol Obstet 296, 1117–1124 (2017). https://doi.org/10.1007/s00404-017-4554-y

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