Skip to main content
SpringerLink
Log in

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.

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

Similar content being viewed by others

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

References

  1. WHO (2005) The World health report: 2005 make every mother and child count. World Health Organization (WHO), Geneva

    Google Scholar 

  2. Devine PC (2009) Obstetric hemorrhage. Semin Perinatol 33:76–81

    Article  PubMed  Google Scholar 

  3. Vegas G, Illescas T, Muñoz M, Pérez-Piñar A (2006) Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol 127:68–72

    Article  PubMed  Google Scholar 

  4. Combs CA, Murphy EL, Laros RK (1991) Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol 77:77–82

    CAS  PubMed  Google Scholar 

  5. Feinberg BB, Resnik E, Hurt WG et al (1987) Angiographic embolization in the management of late postpartum hemorrhage: a case report. J Reprod Med 32:929–931

    CAS  PubMed  Google Scholar 

  6. Pelage JP, Le Dref O, Jacob D, Soyer P, Herbreteau D, Rymer R (1999) Selective arterial embolization of the uterine arteries in the management of intractable post-partum hemorrhage. Acta Obstet Gynecol Scand 78:698–703

    Article  CAS  PubMed  Google Scholar 

  7. Bonnar J (2000) Massive obstetric haemorrhage. Baillieres Best Pract Res Clin Obstet Gynaecol 14:1–18

    Article  CAS  PubMed  Google Scholar 

  8. Deux JF, Bazot M, Le Blanche AF et al (2001) Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol 177:145–149

    Article  CAS  PubMed  Google Scholar 

  9. Joupilla P (1995) Postpartum haemorrhage. Curr Opin Obstet Gynecol 7:446–450

    Article  Google Scholar 

  10. Varner M (1991) Postpartum hemorrhage. Crit Care Clin 7:883–887

    CAS  PubMed  Google Scholar 

  11. Ekin A, Gezer C, Solmaz U, Taner CE, Dogan A, Ozeren M (2015) Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet 292:1247–1254

    Article  PubMed  Google Scholar 

  12. Gonsalves M, Belli A (2010) The role of interventional radiology in obstetric hemorrhage. Cardiovasc Interv Radiol 33:887–895

    Article  CAS  Google Scholar 

  13. Brown BJ, Heaston DK, Poulson AM, Gabert HA, Mineau DE, Miller FJ (1979) Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 54:361–365

    CAS  PubMed  Google Scholar 

  14. Royal College of Obstetricians and Gynaecologists (2007) The role of emergency and elective interventional radiology in postpartum hemorrhage. Royal College of Obstetricians and Gynaecologists Good Practice Guideline No. 6. Royal College of Obstetricians and Gynaecologists, London

  15. Grönvall M, Tikkanen M, Metsätähti M, Loukovaara M, Paavonen J, Stefanovic V (2014) Pelvic arterial embolization in severe obstetric hemorrhage. Acta Obstet Gynecol Scand. doi:10.1111/aogs.12376

    PubMed  Google Scholar 

  16. Tourné G, Collet F, Seffert P, Veyret C (2003) Place of embolization of the uterine arteries in the management of post-partum haemorrhage: a study of 12 cases. Eur J Obstet Gynecol Reprod Biol 110:29–34

    Article  PubMed  Google Scholar 

  17. Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P (2008) Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod 23:1553–1559

    Article  CAS  PubMed  Google Scholar 

  18. Pelage JP, Le Dref O, Mateo J et al (1998) Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 208:359–362

    Article  CAS  PubMed  Google Scholar 

  19. Ratnam LA, Gibson M, Sandhu C, Torrie P, Chandraharan E, Belli AM (2008) Transcatheter pelvic arterial embolisation for control of obstetric and gynaecological haemorrhage. J Obstet Gynaecol 28:573–579

    Article  CAS  PubMed  Google Scholar 

  20. Boulleret C, Chahid T, Gallot D et al (2004) Hypogastric arterial selective and superselective embolization for severe postpartum hemorrhage: a retrospective review of 36 cases. Cardiovasc Interv Radiol 27:344–348

    Article  CAS  Google Scholar 

  21. Ojala K, Perälä J, Kariniemi J, Ranta P, Raudaskoski T, Tekay A (2005) Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage. Acta Obstet Gynecol Scand 84:1075–1080

    PubMed  Google Scholar 

  22. Chung JW, Jeong HJ, Joh JH et al (2003) Percutaneous transcatheter angiographic embolization in the management of obstetric hemorrhage. J Reprod Med 48:268–276

    PubMed  Google Scholar 

  23. Salomon LJ, deTayrac R, Castaigne-Meary V et al (2003) Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod 18:849–852

    Article  CAS  PubMed  Google Scholar 

  24. Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB et al (2009) Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 9:55

    Article  PubMed  PubMed Central  Google Scholar 

  25. Joseph KS, Rouleau J, Kramer MS, Young DC, Liston RM, Baskett TF (2007) Investigation of an increase in postpartum haemorrhage in Canada. BJOG 114:751–759

    Article  CAS  PubMed  Google Scholar 

  26. Callaghan WM, Kuklina EV, Berg CJ (2010) Trends in postpartum hemorrhage: United States, 1994–2006. Am J Obstet Gynecol 202:353.e351–353.e356

    Article  Google Scholar 

  27. Rossen J, Økland I, Bjarte Nilsen O, Eggebø TM (2011) Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Obstet Gynecol Surv 66:18–20

    Article  Google Scholar 

  28. Lutomski JE, Byrne BM, Devane D, Greene RA (2012) Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG 119:306–314

    Article  CAS  PubMed  Google Scholar 

  29. Ford JB, Roberts CL, Simpson JM, Vaughan J, Cameron CA (2007) Increased postpartum hemorrhage rates in Australia. Int J Gynecol Obstet 98:237–243

    Article  CAS  Google Scholar 

  30. Blomberg M (2011) Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol 118:561–568

    Article  PubMed  Google Scholar 

  31. Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Kramer MS, Liston RM, Joseph KS, For the Maternal Health Study Group of the Canadian Perinatal Surveillance System (Public Health Agency of Canada) (2014) Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in canada from 2003 to 2010. J Obstet Gynaecol Can 36(1):21–33

    Article  PubMed  Google Scholar 

  32. Henrich W, Surbek D, Kainer F et al (2008) Diagnosis and treatment of peripartum bleeding. J Perinat Med 36:467–478

    Article  CAS  PubMed  Google Scholar 

  33. American College of Obstetricians and Gynecologists (2006) ACOG practice bulletin: clinical management guidelines for obstetrician–gynecologists number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 108:1039–1047

    Article  Google Scholar 

  34. Bateman BT, Berman MF, Riley LE, Leffert LR (2010) The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 110:1368–1373

    Article  PubMed  Google Scholar 

  35. Huber AW, Raio L, Alberio L, Ghezzi F, Surbek DV (2012) Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage. J Perinat Med 40:43–49

    Article  CAS  Google Scholar 

  36. Doumouchtsis SK, Papageorghiou AT, Arulkumaran S (2007) Systematic review of conservative management of post-partum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv 62:540–547

    Article  PubMed  Google Scholar 

  37. Cheong JY, Kong TW, Son JH, Won JH, Yang JI, Kim HS (2014) Outcome of pelvic arterial embolization for postpartum hemorrhage: a retrospective review of 117 cases. Obstet Gynecol Sci 57(1):17–27

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L (2009) Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol 113:992–999

    Article  PubMed  Google Scholar 

  39. Kim YJ, Yoon CJ, Seong NJ, Kang SG, An SW, Kim YS et al (2013) Failed pelvic arterial embolization for postpartum hemorrhage: clinical outcomes and predictive factors. J Vasc Interv Radiol 24:703–709

    Article  PubMed  Google Scholar 

  40. Flood KM, Said S, Geary M, Robson M, Fitzpatrick C, Malone FD (2009) Changing trends in peripartum hysterectomy over the last 4 decades. Am J Obstet Gynecol 200:632.e1–632.e6

    Article  Google Scholar 

  41. Ghezzi F, Cromi A, Uccella S, Raio L, Bolis P, Surbek D (2007) The Hayman’s technique: a simple method to treat postpartum haemorrhage. BJOG 114:362–365

    Article  CAS  PubMed  Google Scholar 

  42. Zelop CM, Harlow BL, Frigoletto FD et al (1993) Emergency peripartum hysterectomy. Am J Obstet Gynecol 168:1443–1448

    Article  CAS  PubMed  Google Scholar 

  43. Vedantham S, Goodwin SC, Mc Lucas B, Mohr G (1997) Uterine artery embolization: an underused method of controlling pelvic hemorrhage. Am J Obstet Gynecol 176:938–948

    Article  CAS  PubMed  Google Scholar 

  44. Gaia G, Chabrot P, Cassagnes L et al (2009) Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol 19:481–487

    Article  CAS  PubMed  Google Scholar 

  45. Cottier JP, Fignon A, Tranquart F, Herbreteau D (2002) Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 100(5 Pt 2):1074–1077

    CAS  PubMed  Google Scholar 

  46. Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L (2010) Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG 117:84–93

    Article  PubMed  Google Scholar 

  47. Ibrahim MI, Raafat TA, Ellaithy MI, Aly RT (2013) Risk of postpartum uterine synechiae following uterine compression suturing during postpartum haemorrhage. Aust N Z J Obstet Gynaecol 53:37–45

    Article  PubMed  Google Scholar 

  48. Schenker JG, Margalioth EJ (1982) Intrauterine adhesions: an updated appraisal. Fertil Steril 37:593–610

    Article  CAS  PubMed  Google Scholar 

  49. Conforti A, Alviggi C, Mollo A, De Placido G, Magos A (2013) The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol 11:118

    Article  PubMed  PubMed Central  Google Scholar 

Download references

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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Abgottspon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. U. Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Kettenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Surbek
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Ethics declarations

Funding

None.

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4554-y

Keywords

Search

Navigation