Skip to main content
SpringerLink
Log in

Uterine artery Embolization: Interventional Radiologist's Perspective in Management of Uncontrolled Obstetric Hemorrhage

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Purpose

To study the efficacy and safety of uterine artery embolization in treatment of obstetric hemorrhage.

Methods

This ethically approved prospective study was conducted between November 2017 and October 2019, and written informed consent was obtained from all patients. Consecutive patients presenting with uncontrolled obstetric hemorrhage were evaluated. Fifty-three patients with uncontrolled bleeding underwent uterine artery embolization (UAE) and were followed up.

Results

Spectrum of patients encountered in this study was arteriovenous malformations (AVMs) (n = 25), retained products of conception (RPOC) (n = 16), RPOC with secondary AVMs (n = 5), ectopic pregnancy (n = 5) and iatrogenic trauma to cervix or vagina (n = 2). A total of 57 UAE procedures were performed in these 53 patients as repeat sessions were required in four patients. Most common embolic agent used was polyvinyl alcohol (PVA) particles with gelfoam followed by cyanoacrylate glue as second most common agent. Technical success was achieved in 57 (100%) of 57 UAE procedures. Primary clinical success was achieved in 49 (92%) of 53 patients and secondary clinical success in 52 (98%) patients. Clinical failure was observed in one patient who underwent hysterectomy.

Conclusion

Uterine artery embolization is a safe and effective procedure in the management of uncontrolled obstetric hemorrhage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. [Internet]. 2012 [cited 2019 Oct 15]. http://www.myilibrary.com?id=1003393

  2. Vogel JP, Oladapo OT, Dowswell T, Gülmezoglu AM. Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health. 2018;6(1):e18–9.

    Article  Google Scholar 

  3. Themes UFO. Management of Obstetric Hemorrhage [Internet]. Anesthesia Key. 2017 [cited 2019 Oct 15]. https://aneskey.com/management-of-obstetric-hemorrhage/

  4. Masip JM, Toledano LA, FerreroMartínez S, Roig MDG. Massive Postpartum Hemorrhage: Protocol and Red Code. Obstetrics [Internet]. 2017 Dec 20 [cited 2019 Oct 15]; https://www.intechopen.com/books/obstetrics/massive-postpartum-hemorrhage-protocol-and-red-code

  5. Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, et al. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol. 2011;80(3):729–35.

    Article  Google Scholar 

  6. Ohmaru-Nakanishi T, Kuramoto K, Maehara M, Takeuchi R, Oishi H, Ueoka Y. Complications and reproductive outcome after uterine artery embolization for retained products of conception. J Obstet Gynaecol Res. 2019;45(10):2007–14.

    Article  Google Scholar 

  7. Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, et al. Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee. J Vasc Interv Radiol. 2017;28(10):1432-1437.e3.

    Article  Google Scholar 

  8. Song Y, Shin JH, Yoon H-K, Kim JW, Ko G-Y, Won H-S. Bleeding after dilatation and curettage: the efficacy of transcatheter uterine artery embolisation. Clin Radiol. 2015;70(12):1388–92.

    Article  CAS  Google Scholar 

  9. Lee HY, Shin JH, Kim J, Yoon H-K, Ko G-Y, Won H-S, et al. Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution. Radiology. 2012;264(3):903–9.

    Article  Google Scholar 

  10. Aas-Eng MK, Qvigstad E, Kløw N-E, Hald K. The impact of uterine artery embolization to reduce postpartum hysterectomy. Gynecol Surg. 2016;13(3):153–8.

    Article  Google Scholar 

  11. Ganguli S, Stecker MS, Pyne D, Baum RA, Fan C-M. Uterine artery embolization in the treatment of postpartum uterine hemorrhage. J Vasc Interv Radiol. 2011;22(2):169–76.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Mohit Gambhir, Shivanand Gamanagatti, Raju Sharma, Smita Manchanda & Naren Hemachandran

  2. Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Alka Kriplani, Vatsla Dadhwal, Neena Malhotra & J. B. Sharma

Authors
  1. Mohit Gambhir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shivanand Gamanagatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raju Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Smita Manchanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naren Hemachandran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alka Kriplani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vatsla Dadhwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Neena Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. B. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shivanand Gamanagatti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving Human Participants and/or Animals

This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the Institute Ethics Committee of All India Institute of Medical Sciences, New Delhi vide Ref No. IECPG-468/29.11.2017. Informed consent from the patient was taken for both the procedure and for possible publication.

Informed Consent

Informed consent from the patient was taken for both the procedure and for possible publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Dr. Mohit Gambhir, M.D. is a first year Senior Resident in the Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Shivanand Gamanagatti is M.D. and Professor at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Raju Sharma is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Smita Manchanda is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Naren Hemachandran is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Alka Kriplani is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Vatsla Dadhwal is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. Neena Malhotra is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India. Dr. J. B. Sharma is M.D. at Department of Radiodiagnosis at All India Institute of Medical Sciences, New Delhi, India.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gambhir, M., Gamanagatti, S., Sharma, R. et al. Uterine artery Embolization: Interventional Radiologist's Perspective in Management of Uncontrolled Obstetric Hemorrhage. J Obstet Gynecol India 72 (Suppl 1), 126–133 (2022). https://doi.org/10.1007/s13224-021-01567-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-021-01567-x

Keywords

Search

Navigation