Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies

Abstract

Since the initial description of selective uterine artery embolization for the treatment of postpartum hemorrhage in 1979, transcatheter embolization and other endovascular techniques have become the second-line therapeutic option for the management of intractable obstetrical and gynecologic bleeding. Advances in catheter-based techniques, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as postpartum hemorrhage, menorrhagia, and postmenopausal bleeding. Transcatheter interventions include the following: (1) prophylactic selective catheterization of the internal iliac arteries, with either temporary balloon occlusion or embolotherapy; (2) selective embolization of collateral pelvic vessels in the setting of surgical ligation of the internal iliac arteries and/or delivery-related injuries to the genital tract; (3) transarterial embolization for the management of abnormal placentation; and (4) massive bleeding secondary to uterine leiomyomas (fibroids) and/or arteriovenous malformations. Transcatheter embolization is a fast, safe, and effective minimally invasive alternative to hysterectomy, when medical treatment fails to control uterine bleeding. Moreover, it preserves the uterus with little or no significant impact on future pregnancies and fertility. This article reviews the transcatheter endovascular techniques that are used in a variety of clinical scenarios for the management of obstetrical and gynecologic emergencies.