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Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization

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Abstract

Objective

This study was designed to determine the incidence of arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic arterial embolization for the treatment of this condition.

Study design

Eighteen women with pelvic arterial pseudoaneurysm were retrieved from a series of 588 consecutive patients with PPH treated by arterial embolization. Clinical files, angiographic examinations, and procedure details were reviewed.

Results

The incidence of pseudoaneurysm was 3.06 % (18/588; 95 % confidence interval (CI): 1.82–4.8 %). A total of 20 pseudoaneurysms were found; 15/20 (75 %) were located on the uterine arteries. Angiography revealed extravasation of contrast material from pseudoaneurysm indicating rupture in 9 of 18 (50 %) patients. Arterial embolization was performed using gelatin sponge alone in 12 of 18 (67 %) patients or in association with metallic coils in 5 of 18 (28 %) patients or n-butyl-2-cyanoacrylate in 1 of 18 (6 %) patients. Arterial embolization allowed controlling the bleeding in all patients after one or two embolization sessions in 17 of 18 (94 %) and 1 of 18 patients (6 %) respectively, without complications, obviating the need for further surgery.

Conclusions

Pseudoaneurysm is rarely associated with PPH. Arterial embolization is an effective and safe procedure for the treatment of PPH due to uterine or vaginal artery pseudoaneurysm. Our results suggest that gelatin sponge is effective for the treatment of ruptured pseudoaneurysms, although we agree that our series does not contain sufficient material to allow drawing definitive conclusions with respect to the most effective embolic material.

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Conflict of interest

Anthony Dohan, Philippe Soyer, Aqeel Subhani, Delphine Hequet, Yann Fargeaudou, Olivier Morel, Mourad Boudiaf, Etienne Gayat, Emmanuel Barranger, Olivier Le Dref, and Marc Sirol declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Anthony Dohan, Philippe Soyer, Aqeel Subhani, Yann Fargeaudou, Mourad Boudiaf, Olivier Le Dref & Marc Sirol

  2. Université Paris-Diderot, Sorbonne Paris Cité, 10 rue de Verdun, 75010, Paris, France

    Anthony Dohan, Philippe Soyer, Delphine Hequet, Emmanuel Barranger & Marc Sirol

  3. Department of Obstetric and Gynecology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Delphine Hequet & Emmanuel Barranger

  4. Maternité Universitaire de Nancy, Université Henri Poincaré Nancy 1, 10 rue du Docteur Heydenreich, 54000, Nancy, France

    Olivier Morel

  5. Department of Anesthesiology and Intensive Care Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France

    Etienne Gayat

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  1. Anthony Dohan
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  2. Philippe Soyer
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Correspondence to Philippe Soyer.

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Dohan, A., Soyer, P., Subhani, A. et al. Postpartum Hemorrhage Resulting from Pelvic Pseudoaneurysm: A Retrospective Analysis of 588 Consecutive Cases Treated by Arterial Embolization. Cardiovasc Intervent Radiol 36, 1247–1255 (2013). https://doi.org/10.1007/s00270-013-0668-1

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