Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage.

AIM

To present the findings of uterine artery embolization (UAE) in the management of obstetric haemorrhage.

MATERIALS AND METHODS

From October 1999 to February 2003, 10 women with postpartum haemorrhage (n=7) and post-abortion haemorrhage with placenta accreta (n=3), were referred to our department for pelvic angiography and possible arterial embolization.

RESULTS

Angiography revealed engorged and tortuous uterine arteries in all patients; and contrast medium extravasation in three patients. Eight patients (three with and five without detectable active bleeding) then underwent bilateral UAE. Medium-sized (250-355 microm) polyvinyl alcohol particles were injected via a coaxial catheter into the uterine arteries, followed by gelatin sponge pieces via a 4F Cobra catheter. Microcoil devascularization was also performed in the two patients with visible, active bleeding. The vaginal bleeding resolved in all patients, without any ischaemic complications. At follow-up, all patients who underwent UAE had normal menstruation; three of them subsequently gave birth to full-term healthy babies.

CONCLUSION

Selective UAE by the coaxial method is safe and effective to control obstetric haemorrhage, with the potential to preserve fertility.