Document Detail

Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage.
MedLine Citation:
PMID:  19384113     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To estimate what factors are associated with a failed pelvic arterial embolization for postpartum hemorrhage and to attempt to estimate efficacy of pelvic arterial embolization in rare conditions. METHODS: This was a retrospective cohort study including all consecutive women who underwent pelvic arterial embolization trial for postpartum hemorrhage between 1994 and 2007 at a tertiary care center. Pelvic arterial embolization failure was defined as the requirement for subsequent surgical procedure to control postpartum hemorrhage. RESULTS: Pelvic arterial embolization was attempted in 0.3% of deliveries by the same radiologist in 87% of cases. Failures occurred in 11 of 100 cases (11%) and in 4 of 17 cases (24%) of placenta accreta or percreta. The major complication rate after pelvic arterial embolization was low (3%). Fifty patients (50%) were transferred from nine other institutions. Pelvic arterial embolization was performed in 11 cases (11%) after a failed conservative surgical procedure and in eight cases (8%) for secondary postpartum hemorrhage, with success rates of 91% and 88%, respectively. Pelvic arterial embolization demonstrated a patency throughout one ligated pedicle in 9 of the 11 cases of failed conservative surgical procedure (82%). Twin pregnancy, chorioamnionitis, operative vaginal delivery, hospital-to-hospital transfer, nature of embolizing agent and arteries embolized, failed surgical procedure, secondary postpartum hemorrhage, cause of postpartum hemorrhage, and more than one pelvic arterial embolization were not found to be significantly associated with failed pelvic arterial embolization. CONCLUSION: The only factors significantly associated with failed pelvic arterial embolization were a higher rate of estimated blood loss (more than 1,500 mL) and more than 5 transfused red blood cell units. Attempted pelvic arterial embolization after a failed vessel ligation procedure and for a secondary postpartum hemorrhage is a good option with high success rates.
Loïc Sentilhes; Alexis Gromez; Erick Clavier; Benoît Resch; Eric Verspyck; Loïc Marpeau
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  113     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-22     Completed Date:  2009-05-28     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  992-9     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, Rouen University Hospital, Charles Nicolle, Rouen, France.
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MeSH Terms
Cohort Studies
Postpartum Hemorrhage / etiology,  pathology,  therapy*
Retrospective Studies
Risk Factors
Treatment Failure
Uterine Artery Embolization*
Young Adult

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