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Review
. 2013 Dec;30(4):333-9.
doi: 10.1055/s-0033-1359726.

Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes

Matthew G Gipson  1 , Mitchell T Smith  1
Affiliations
Review

Endovascular therapies for primary postpartum hemorrhage: techniques and outcomes

Matthew G Gipson et al. Semin Intervent Radiol. 2013 Dec.

Abstract

Interventional radiologists are often consulted for acute management of hemorrhagic complications in obstetric and gynecologic patients. The aim of this article is to review the common indications for vascular embolization in obstetric and gynecologic emergencies, specifically in the setting of primary postpartum hemorrhage, and to discuss the technique and outcomes of endovascular treatment.

Keywords: balloon occlusion catheter; embolization; endovascular; postpartum hemorrhage.

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Figures

Figure 1
Figure 1
Types of placenta accreta. (A) Normal, (B) accreta, (C) increta, and (D) percreta.
Figure 2
Figure 2
A 32-year-old woman (G1P0) with recalcitrant blood loss after vaginal delivery. Left-sided anterior division hypogastric arteriography (A, B) demonstrates no angiographic findings of active hemorrhage (Roberts uterine catheter is formed in distal abdominal aorta [black arrow]). (C) Uterine artery angiogram through microcatheter (white arrow) demonstrates pruning of the uterine artery with occlusion of distal branches with gelfoam slurry cast (arrowheads).
Figure 3
Figure 3
A 38-year-old woman (G1P1) status post primary low cesarean section via Pfannenstiel incision who became tachycardic and hypotensive with rapid onset vaginal bleeding after delivery. Patient failed resuscitation with blood products and trial of lower uterine segment balloon tamponade. (A) Early arterial and (B) late arterial digital subtraction angiography (DSA) demonstrates a pseudoaneurysm (open arrow) arising from the uterine artery with active hemorrhage into the pelvis. (C) DSA of the uterine artery and (D) flush aortogram after transcatheter coiling demonstrates cessation of hemorrhage with coil pack (arrows) in the right hemipelvis.
Figure 4
Figure 4
A 34-year-old woman (G3P2) with complete placenta previa and percreta who underwent preoperative balloon catheter placement for scheduled cesarean delivery. (A) Right-sided hypogastric artery digital subtraction angiography (DSA) after balloon catheter inflation demonstrates good position of the occlusion balloon (open arrow) and stasis of forward flow. (B) DSA native image redemonstrates balloon catheter (white arrow) and bilateral 7-French sheath tips (arrowheads). Radio-opaque fetal monitoring equipment overlies the anterior abdomen (black arrow).
See this image and copyright information in PMC

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