Transcatheter arterial embolization in the management of postpartum hemorrhage due to genital tract injury

Six patients with uncontrollable postpartum hemorrhage due to genital tract injury were treated with transcatheter arterial embolization. The causes of hemorrhage were laceration of the cervix and vagina in five cases and rupture of the uterus in one. Four cases included a large hematoma in the paravaginal and/or retroperitoneal space. Two women had a hysterectomy before arterial embolization. Angiography revealed extravasation in five cases. All six subjects had their hemorrhage arrested dramatically using transcatheter arterial embolization with gelatin sponge particles. No major complication was encountered in any case. Normal menstruation resumed in the women who did not undergo a hysterectomy. Transcatheter arterial embolization therapy seems to be the treatment of choice in patients with uncontrollable hemorrhage.