Clinical and Angiographic Features of Secondary Postpartum Hemorrhage and the Outcomes of Transcatheter Arterial Embolization

ABSTRACT

PURPOSE@#To analyze the clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage.@*MATERIALS AND METHODS@#Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center.@*RESULTS@#Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (p < 0.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n = 7), and microcoil (n = 7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months.@*CONCLUSION@#Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered.