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Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases

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Abstract

Objective

To evaluate pelvic artery embolisation (PAE) in the emergency management of intractable postpartum haemorrhage (PPH) associated with placenta accreta (PA).

Methods

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.

Results

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.

Conclusion

PAE can be performed safely and effectively for patients with PPH and PA and can preserve the uterus in many patients.

Key Points

• 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.

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Acknowledgments

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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Authors and Affiliations

  1. Department of Radiology, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, Republic of Korea

    Sook Min Hwang, Gyeong Sik Jeon, Sang Heum Kim & Jong Tae Lee

  2. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Man Deuk Kim

  3. Department of Radiology, Dankook University Hospital, Cheonan, Chungcheongnam-do, 330-715, Republic of Korea

    Min Jeong Choi

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  1. Sook Min Hwang
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  2. Gyeong Sik Jeon
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Correspondence to Gyeong Sik Jeon.

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Hwang, S.M., Jeon, G.S., Kim, M.D. et al. Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases. Eur Radiol 23, 766–773 (2013). https://doi.org/10.1007/s00330-012-2612-1

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  • DOI: https://doi.org/10.1007/s00330-012-2612-1

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