Urgent Transcatheter Arterial Embolization In Intractable Postpartum Hemorrhage.

Objective:To assess the efficacy and safety of emergency transcatheter arterial embolization in the management of intractable postpartum hemorrhage. Methods:25women with intractable postpartum hemorrhage(primary,n=15(60%) secondary,n=10(40%)) underwent femoral artery puncture by Seldinger's technique between 2000 and 2004.The age of the patients ranged between 21 and 41 years with a mean age of 31.7.Forteen women(56%) were urgently transferred from another institution.Uterine atony and lower genital tract laceration were the most common causes of postpartum hemorrhage.There did not include the patients of DIC who with other organs continuous bleeding. 5 patients delivered by cesarean and 15 vaginally.Five were after artificial abortion.Disseminated intravascular coagulation was present in 15(60%) patients before embolization.These procedures were performed using the DSA machine(PHILIPS V5000),A 4F catheter was used with a hydrophilic polymer-coated 0.035 inch guidedwire.Superselective catheterization to the bilateral internal iliac arteries or uterial arterial and the arterial embolization with gelfoam particles soaked in the Gentamycin sulfate was followed after the bleeding sources and causes was proved. Bilateral internal iliac artery embolization was performed to shorten procedure time if the patients with severe hypovolemic shock during the procedure. Results:All of the 25 patients with obstetrical bleeding were successfully controlled. TAE lasted 30-60min,mean 45.2±4.8min,and the clinical success was 100%.All the coagulation disorders were corrected after infusing fluid and blood transfusion.DSA showed diffuse extravasation of contrast agent in 17 cases and bleeding arised from 4 vaginal arteries,3 uterus arteries and one pudendal artery.All patients were followed up for 3-40 months and no major complication of embolization therapy was observed. Menstruation resumed in all patienta. Conclutions: With less complications emergency arterial embolization is a safe and effective means of control intactable postpartum hemorrhage.