Safety and Efficacy of Arterial Embolization for Secondary Postpartum Hemorrhage

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Kevin Shixiao He, MD, FRCPC (he/him/his)

Interventional Radiology Fellow
UHN/University of Toronto

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

TR

Taryn Rohringer, MD

Radiology Resident
University of Toronto
John R. Kachura, MD, FRCPC, FSIR

Professor
University of Toronto

Disclosure(s):

Kevin Shixiao He, MD, FRCPC: No financial relationships to disclose

John R. Kachura, MD, FRCPC, FSIR: No financial relationships to disclose

Purpose:

To evaluate the efficacy and safety of arterial embolization for treatment of secondary postpartum hemorrhage (PPH), and the factors associated with clinical success.

Materials and Methods:

A retrospective analysis of all patients undergoing arterial embolization for secondary PPH ( >24h postpartum) at 3 tertiary centers from 2004 through 2021 was conducted. Patient details, delivery details, transfusion requirements, hematology and coagulation results, embolization details, and clinical outcomes were collected. Clinical success was defined as cessation of hemorrhage without the need for repeat embolization, laparotomy, or hysterectomy after embolization. The Fisher exact test was used to analyze nonparametric data.

Results:

25 patients (mean age 35 years, range 25-44 y) had secondary PPH after delivery, occurring on average at 16 days (range 2-58 d). Most frequent causes of secondary PPH were retained products of conception (28%, 7 of 25), vascular uterine abnormalities (16%, 4 of 25), placental attachment disorders (16%, 4 of 25), and pseudoaneurysms (12%, 3 of 25). Majority of patients (56%, 14 of 25) had prior procedural intervention prior to embolization, with the most common being dilatation and curettage (93%, 13 of 14). Technical success was 100%, with clinical success rate 92% (23 of 25). Both patients who had ongoing hemorrhage (2 of 25) achieved clinical success with a repeat embolization procedure. There were no complications requiring additional treatment or prolonged hospitalization. 24% of patients (6 of 25) became pregnant following embolization. Clinical success of embolization for secondary PPH was not related to mode of delivery, cause of PPH, timing of PPH, or type of prior procedure (p >0.05).

Conclusion:

Arterial embolization for secondary PPH is safe, effective, and likely to preserve fertility. Embolization should be considered as an option for patients who failed initial management by dilatation and curettage.