Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology

Abstract

(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage.

Keywords: endovascular therapy; management; vaginal hemorrhage.

Scheme 1

The distribution of the patients according to the cause of hemorrhage.

Scheme 2

The distribution of the patients diagnosed with anemia.

Figure 1

Uterine artery embolization in uterine leiomyoma.

Figure 2

Selective artery embolization in patient with cervical neoplasia.

Figure 3

Selective long vaginal artery embolization in patient with cervical neoplasia.

Figure 4

Pelvic artery embolization for cervical ectopic pregnancy.

Figure 5

Pelvic artery embolization for C-scar ectopic pregnancy.

Figure 6

Selective artery embolization in patient with arterial venous malformation.

Scheme 3

The distribution of the patients diagnosed with uterine fibroids with dysfunctional metrorrhagia according to the severity of the hemorrhage.

Scheme 4

The effect of PAE on dysfunctional metrorrhagia in patients diagnosed with uterine fibroids.