Postpartum hemorrhage with uterine artery embolization: the risk of complications of uterine artery embolization

Abstract

Introduction

The purpose of this study was to evaluate the efficacy and adverse effects of uterine artery embolization (UAE) to treat postpartum hemorrhage (PPH) and determine the factors associated with clinical outcomes.

Material and methods

This study included 117 patients who underwent UAE for PPH between January 2010 and November 2018. Their medical records were retrospectively reviewed to assess the mode of delivery, causes of bleeding, detailed laboratory results, clinical outcomes, time from delivery to UAE, and embolizing material used.

Results

The clinical UAE success rate was 99.1%. Late complications were found in 11 patients. Two total hysterectomies were performed. Most PPH cases treated with UAE had early-onset PPH caused by uterine atony. Late-onset PPH was caused by placenta-related problems (remnant placenta, placenta accreta). Body mass index, cesarean section, the use of mixed embolizing materials, placenta abruption as the cause of PPH, and transferred patients were associated with uterine necrosis. Age, re-embolization, and the use of mixed embolizing materials were associated with adverse complications.

Conclusions

Although UAE is a safe and effective way to manage PPH, a long-term follow-up is needed to determine the complications of UAE. When uterine necrosis is suspected, prompt and adequate treatment should be performed due to the effects of necrosis on menstrual cycles, fertility, and subsequent pregnancies.

Keywords:

• Uterine artery embolization
• postpartum hemorrhage
• uterine necrosis
• adverse complications

Acknowledgments

Statistical consultation was provided by the Department of Biostatistics of the Catholic Research Coordinating Center.

Declaration of interest

The author reports no conflicts of interest. The authors alone are responsible for the content and writing of this paper.