双侧子宫动脉栓塞术对预防和治疗产后出血的临床应用价值

目的：探究双侧子宫动脉栓塞术对预防和治疗产后出血的临床应用价值。方法54例出现难治性产后出血患者（治疗组）及40例具有产后出血高危因素的患者（预防组）均进行双侧子宫动脉栓塞术,观察疗效及出现的不良反应等。结果治疗组产妇治疗前已出现产后出血,出血量1100～4300 mL,平均2100 mL,辅助性背带缝合3例,宫腔填纱13例;预防组产妇出血量为210～490 mL,平均370 mL,所有患者均未发生产后出血;栓塞术后52例患者均有效,有效率96.3％,患者术后均未出现不良反应。结论双侧子宫动脉栓塞术是一种安全有效且不良反应小的治疗手段,对产后大出血高危因素患者有预防作用,是治疗难治性产后出血的有效方法。     

急症动脉栓塞治疗难治性产后出血疗效评价

目的评价急症经导管动脉栓塞术(TAE)治疗难治性产后出血的疗效及安全性。方法临床25例难治性产后出血患者,采用右股动脉Seldinger穿刺技术,选择性插管至双侧髂内动脉或子宫动脉,行DSA明确出血部位后以明胶海绵颗粒栓塞。结果插管成功率100%,手术时间25～60min,平均(42.5±4.6)min,术后止血时间3～15min。术后止血总有效率100%。比较术前术后患者血红蛋白及心率,差异具有显著性(t=29.49,P<0.01;t=16.51,P<0.01)。所有患者宫体按期复旧,转经后月经正常。结论TAE创伤小,疗效快速肯定,术后短期及长期随访无严重并发症,对危及生命的产后出血是一种有效治疗措施。     

产后出血及晚期产后出血的介入治疗

目的：探讨髂内动脉或子宫动脉栓塞(简称动脉栓塞)治疗产后出血及晚期产后出血。方法：23例产后出血及晚期产后出血患者，采用sekdinger技术，用明胶海绵颗粒栓塞出血动脉止血。结果：23例大出血患者，栓塞后干3个月、6个月随访复查，除1例栓塞失败外，其余22例均未再异常出血，效果满意。结论：动脉栓塞术是治疗产后出血及晚期产后出血安全而有效的方法。     

急诊介入栓塞止血治疗产后大出血临床研究

目的：探讨产后大出血急诊介入栓塞止血的价值。方法：本组27例产后大出血，出血量1000－5000ml，出血原因为：中央型前置胎盘，宫颈妊娠，产后，胎盘粘连和滞留，宫缩乏力，妊娠高血压综合征（妊高征），凝血功能联障碍等，多数患者为复合笥因素。经临床紧急抢救，输血，抗体克，清宫，使用宫缩剂，止血剂，缝合或（和）阴道填塞止血等处理，难于控制出血者急诊介入栓塞止血，采用超选择髂内动脉前支插管，造影明确诊断后用明胶海绵条或碎片栓塞靶动脉。结果：插管成功率96．3％，发现1例异位子宫动脉。栓塞后立即止血22例（81．5％），渐止血4例（14．81％），总有效率96．3％。8例合并产后DIC，其中1例伴有多脏器损伤；11例失血性休克均抢救成功。1例插管未找到子宫动脉，而改作子宫切除术。本组无栓塞并发症及病死率。结论：急诊介入栓塞止血是抢救危及生命的产后大出血的理想方法，不仅能抢救产妇的生命，而且能保留产妇子宫，对抢救产后DIC也有良效，值得推广应用。     

动脉栓塞治疗难治性产后出血疗效观察

目的观察动脉栓塞治疗难治性产后出血的效果。方法收集我院2008-01至2012-12因难治性产后出血行动脉栓塞治疗的24例患者的临床资料,电话随访患者术后月经恢复、生育及其他有关信息。结果 22例(91.7%)患者经动脉栓塞后出血得以成功控制,2例(8.3%)患者因栓塞不成功而经腹行全子宫切除术;1例(4.2%)术后42 d复查发现宫腔积血行宫腔镜检查,未发现宫腔粘连;2例(8.3%)患者失访,19例(96.4%)患者月经均恢复。仅随访到1例患者栓塞2年后再次妊娠。所有随访对象未发现其他并发症。结论动脉栓塞是一种安全有效、无创的控制产后出血的方法,且对患者远期月经恢复无明显不良影响,而对生育是否有影响需进一步随访,未随访到其他的不良影响。     

医用胶栓塞肾脏假性动脉瘤疗效分析

目的：探讨液体医用胶结合微导管超选择插管技术栓塞治疗肾脏假性动脉瘤的安全性及有效性。方法回顾性分析2009年10月至2014年1月肾动脉造影诊断为肾脏假性动脉瘤并接受福爱乐医用胶栓塞出血血管的23例患者临床资料。23例患者有28枚肾脏假性动脉瘤（18例医源性损伤患者有21枚,5例外伤患者有7枚）,均经3 F微导管超选择插管至肾脏假性动脉瘤载瘤动脉,造影明确后在减影下经微导管向假性动脉瘤内注入福爱乐医用胶－碘化油1∶1混合液栓塞出血血管。观察假性动脉瘤栓塞成功率、术后血尿及肾功能。结果23例28枚肾脏假性动脉瘤均栓塞成功,福爱乐医用胶平均用量0．4 ml（0．2～1 ml）。3例患者载瘤动脉邻近3级分支血管出现异位栓塞,无2级分支血管及肾动脉主干血管异位栓塞。1例假性动脉瘤直径＞2 cm患者术后2 d持续存在血尿,再次造影后于载瘤动脉补充塔形弹簧圈1枚,出血停止。其余患者在3个月随访期间均未再出现血尿情况。4例术后血清肌酐有轻度升高。结论福爱乐医用胶结合微导管超选择插管栓塞肾脏假性动脉瘤迅速,栓塞成功率高,术后再出血发生率低,疗效确切。     

经动脉栓塞治疗腹腔肿瘤患者术后大出血13例

目的探讨经动脉栓塞治疗腹腔肿瘤患者术后大出血的可行性及疗效。方法 2004年1月至2009年12月13例腹腔肿瘤患者因术后大出血接受经动脉栓塞治疗。对这些患者的临床资料及造影栓塞过程进行回顾性分析。结果 13例患者中有10例经过一次栓塞出血即得到控制。在栓塞后再次出现出血的3例患者,血管造影发现出血动脉不同。2例经再次栓塞出血得到控制,1例由于微导管无法超选择到出血部位而行手术治疗。经动脉栓塞治疗术后大出血总的临床成功率为92%（12/13）。未出现严重并发症。结论经动脉栓塞治疗腹腔肿瘤患者术后大出血安全、可行。     

选择性脾动脉栓塞的临床意义

目的：研究和分析对脾动脉不同部位的栓塞治疗不同疾病的临床效果和方法,方法：选择23例患者,肝硬化合并肝癌6例,单纯肝硬化门脉高压食道胃底静脉破裂出血13例,脾功能亢进4例,男19例,女4例,对19例患者采取脾动脉主干栓塞,而后4例患者作部分性脾实质栓塞（即对部分脾段动脉进行栓塞）。结果：13例肝硬化门脉高压食道-胃底静脉曲张破裂出血的患者于脾动脉主干栓塞后,出血立即停止,除1例栓塞1月后再次出血,1例历肾功能衰竭于栓塞术后48h死亡外,其余11例一年内未再次出血;6例肝癌行脾动脉主干栓塞后进行了肝癌的灌注栓塞（TACE）治疗,未发生术后上消化道出血;4例脾亢患者行脾段动脉栓塞后,第3天白细胞及血小板有明显升高,除左上腹疼痛及发热较明显外,无其他并发症,所有栓塞治疗比较安全,结论：通过动脉超选择性插管栓塞术,可以治疗脾亢及门脉高压引起的上消化道大出血,且保留了脾脏功能,所有治疗方法操作简单、安全有效,值得推广运用。     

头颈部CT血管造影在鼻咽癌放疗后并发鼻出血介入术前评估中的应用

目的 探讨头颈部CT血管造影（CTA）检查在鼻咽癌（NPC）放疗后出现难治性鼻出血行血管介入术前评估中的应用价值,从而指导临床快速有效的抢救鼻出血患者。方法 回顾分析2016年1月至2021年1月期间在我院治疗的28例NPC放疗后合并难治性鼻出血患者的临床资料,所有患者术前均在确保气道通畅的前提下行头颈部CTA检查,根据CTA检查结果做好气道保护措施及确认手术方案,急诊行血管造影及栓塞责任血管治疗,并进一步观察止血率及抢救成功率。结果 所有28例患者术前均完成头颈部CTA检查,其中发现颈内动脉假性动脉瘤（PSA）4例（右侧3例,左侧1例）,颈外动脉PSA 1例,术前行气管插管4例,气管切开1例,所有患者均未出现出血窒息的情况。术中所有患者均行头颈部血管造影检查并成功完成介入栓塞治疗;其中1例因术中大量出血出现烦躁不能配合而暂停介入操作,经气管插管等处理后完成治疗。术后1周内1例合并PSA患者出现鼻出血再发,再次介入栓塞止血治疗。介入手术止血率96.4%,抢救成功率100%。结论 术前常规快速的头颈部CTA检查,可帮助指导鼻咽癌患者术前的气道保护及术中更快速找寻责任血管并栓塞治疗,可帮助...     

前列腺动脉栓塞术治疗前列腺源性血尿临床效果北大核心CSCD

目的评价前列腺动脉栓塞术(PAE)治疗前列腺源性血尿的临床效果。方法回顾性分析2016年6月至2019年8月在福建省立医院因前列腺源性血尿接受PAE治疗的21例患者临床资料、造影表现及治疗效果。PAE技术成功的定义为双侧超选择插管并栓塞前列腺动脉。止血成功定义为PAE即刻止血或术后72 h内不需进一步干预情况下血尿控制。结果PAE术后21例患者中4例DSA造影可见对比剂外渗或小动脉瘤形成。2例良性前列腺增生患者一侧前列腺动脉迂曲严重,微导管无法超选进入,其余患者均成功实施双侧超选前列腺动脉栓塞,技术成功率为90.5%(19/21);20例止血成功,肉眼血尿在24 h内消失,止血率为95.2%(20/21),1例前列腺增生患者术后3 d仍有活动性肉眼血尿,转入外科手术。结论PAE治疗前列腺源性血尿微创、有效,值得临床推广应用。     

Primary postpartum hemorrhage: outcome of pelvic arterial embolization in 251 patients at a single institution

Purpose: To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for the treatment of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes. Materials and Methods: This retrospective single-center study was institutional review board approved, and informed consent was waived. Outcomes were analyzed in 251 patients who underwent PAE for primary PPH between January 2000 and February 2011. Mode of delivery, causes of bleeding, detailed laboratory and treatment records, and clinical outcomes were recorded. Clinical success was defined as cessation of bleeding after initial session of PAE without the need for additional PAE or surgery. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes. Results: The clinical success rate was 86.5% (217 of 251). Among the 34 failed cases, 12 underwent repeat PAE, 16 underwent additional surgery, and three recovered with conservative management. Overall bleeding control was achieved in 98.0% (246 of 251) of the patients. Overall mortality was 2% (five of 251) after the first (n = 3) or second (n = 1) session of PAE or additional surgery (n = 1). Among the 113 patients with long-term follow-up, 110 (97.3%) maintained a regular menstrual cycle and 11 had successful pregnancies. Univariate analysis showed that cesarean section delivery, disseminated intravascular coagulation (DIC), and massive transfusion of more than 10 red blood cell units were related to failed PAE. Multivariate analysis showed that DIC (odds ratio, 0.36; P = .04) and massive transfusion (odds ratio, 0.10; P < .001) were significantly related to clinical failure. Conclusion: PAE is safe and effective for managing primary PPH. Patients with DIC and massive transfusion were likely to have poor results after PAE. ? RSNA, 2012.     

Transcatheter Arterial Embolization for Secondary Postpartum Hemorrhage: Outcome in 52 Patients at a Single Tertiary Referral Center

PurposeTo assess the safety and efficacy of transcatheter arterial embolization (TAE) for the management of secondary postpartum hemorrhage (PPH) and to determine the factors associated with the clinical outcomes.Materials and MethodsA retrospective analysis of 52 patients (mean age, 31.6 y; range, 25–40 y) undergoing TAE for secondary PPH was performed. Clinical data, including maternal characteristics, delivery details, embolization details, and transfusion requirements, were obtained. Univariate analyses were performed to determine the factors related to clinical outcomes.ResultsThe major cause of bleeding was retained placental tissue (44.2%; 23 of 52). Actively bleeding foci were observed in 25 (48.1%) patients. Technical and clinical successes were achieved in 100% and 90.4% (47 of 52) of patients, respectively. Gelatin sponge particles with (n = 10) or without (n = 38) permanent embolic materials, such as microcoils or N-butyl cyanoacrylate, were most commonly used (92.3%; 48 of 52), whereas permanent embolic materials alone were used in 7.7% (4 of 52) of patients. In five patients, embolization failed, and these patients were managed by hysterectomy (n = 3), repeat TAE (n = 1), or conservative management (n = 1). Bleeding control was eventually achieved in all five patients. No maternal risk factors were related to clinical results. The median and mean follow-up periods were 3 months and 12.6 months (range, 1–62 mo). Regular menstruation resumed in all 44 patients with available follow-up, and 5 of the patients became pregnant.ConclusionsTAE for secondary PPH is safe and effective and showed technical and clinical success in 100% and 90.4% of patients, respectively. Approximately half of these patients showed a positive bleeding focus, and the use of permanent embolic materials was also common.     

Failed Pelvic Arterial Embolization for Postpartum Hemorrhage: Clinical Outcomes and Predictive Factors

PurposeTo evaluate clinical outcomes of failed pelvic arterial embolization (PAE) and determine predictive factors associated with this failure in the treatment of postpartum hemorrhage (PPH).Materials and MethodsThis retrospective study included all consecutive patients who underwent PAE for life-threatening PPH between March 2004 and January 2011 at a tertiary-care center. Medical records and imaging studies were reviewed to identify cases of failed PAE and their clinical outcomes. Multiple parameters were compared between the failed and successful PAE groups, and multivariate analysis was performed to determine the predictive factors associated with failed PAE.ResultsPAE was performed in 257 patients (mean age, 32 y; range, 20–40 y). A total of 24 cases of PAE involved a failure to achieve hemostasis (9.3%). Patients in the failed PAE group experienced more major complications than those in the successful PAE group (37.5% [nine of 24] vs 9.4% [22 of 233]). Factors more frequently found in failed PAE included hemodynamic instability, hemoglobin level lower than 8 g/dL, disseminated intravascular coagulation (DIC), and extravasation detected on angiography. After multivariate analysis, DIC emerged as the only significant predictive factor (odds ratio, 6.569; 95% confidence interval, 1.602–26.932; P = .009).ConclusionsPAE is an effective treatment for medically intractable PPH. However, PAE failed in a high percentage of patients and was commonly associated with major complications. DIC was the only significant predictor of failed PAE.     

Transcatheter arterial embolisation for the management of obstetric haemorrhage associated with placental abnormality in 40 cases

Objective

To evaluate pelvic artery embolisation (PAE) in the emergency management of intractable postpartum haemorrhage (PPH) associated with placenta accreta (PA).

Methods

Forty such patients (PAE for PPH/PA) were retrospectively reviewed. Medical records were reviewed regarding the delivery and PAE procedure. Follow-up gynaecological outcomes after PAE were obtained by telephone interviews.

Results

Technical success was achieved in all women (100 %). The initial clinical success rate was 82.5 % (33/40). Three patients with PA underwent hysterectomy after PAE failed to stop the bleeding within 24 h after the embolisation. The other three patients underwent re-embolisation (two patients underwent re-embolisation on the next day and one patient had undergone re-embolisation 6 h after the first embolisation), and bleeding had stopped eventually. The clinical success rate was 92.5 %. There were four cases of immediate complications, such as, pelvic pain, nausea and urticaria. There were three late minor complications, temporary menopause, but no late major complications. After the procedure, 35 patients resumed normal menstruation, including two uncomplicated pregnancies. One patient expired owing to disseminated intravascular coagulopathy and intracerebral haemorrhage, despite successful embolisation.

Conclusion

PAE can be performed safely and effectively for patients with PPH and PA and can preserve the uterus in many patients.

Key Points

? Pelvic artery embolisation (PAE) is an important therapeutic option for postpartum haemorrhage. ? It seems safe and effective for PPH with placenta accreta (PA). ? PAE preserves the uterus and does not impair subsequent menstruation. ? PAE has few major complications.     

Transcatheter Arterial Embolization in the Management of Postpartum Hemorrhage due to Genital Tract Injury after Vaginal Delivery

PurposeTo evaluate efficacy and safety of transcatheter arterial embolization (TAE) in managing postpartum hemorrhage (PPH) due to genital tract injury after vaginal delivery and to investigate factors associated with outcome of TAE.Materials and MethodsA retrospective review of 43 women (mean age, 32.6 years) who underwent TAE to manage PPH secondary to genital tract injury after vaginal delivery was performed at a single institution between January 2007 and December 2018. Clinical data and outcomes were obtained. Patients were classified into clinical success (n = 39) and failure (n = 4) groups, and comparisons between the groups were performed.ResultsThe clinical success rate of TAE for PPH due to genital tract injury was 90.7%. In the clinical failure group, transfusion volumes were higher (failure vs success: packed red blood cells, 14 pt ± 3.37 vs 6.26 pt ± 4.52, P = .003; platelets, 10.33 pt ± 4.04 vs 2.92 pt ± 6.15, P = .036); hemoglobin levels before the procedure were lower (failure vs success: 7.3 g/dL vs 10.7, P = .016). Periprocedural complications included pulmonary edema (25.6%), fever (23.3%), and pain (9.3%). Twenty-four patients were either followed for > 6 months or answered a telephone survey; 23 (95.8%) recovered regular menstruation, and pregnancy was confirmed in 11 (45.8%). Regarding fertility desires, 7 women attempted to conceive, 6 of whom (85.7%) became pregnant.ConclusionsTAE is an effective and safe method for managing PPH due to genital tract injury after vaginal delivery. Lower hemoglobin levels before the procedure and higher transfusion volumes were associated with clinical failure of TAE.     

Classification of uterine artery angiographic images: a predictive factor of failure in uterine artery embolization for postpartum hemorrhage

Purpose

To justify a classification system for angiographic images of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) and identify new risk factors associated with failed embolization.

Materials and methods

A retrospective analysis of 63 consecutive patients who underwent UAE for severe PPH was performed. Uterine artery angiography (UA) before embolization was classified into two types: type 1 was defined as complete staining and type 2 was defined as partial staining of the uterine arteries. The clinical outcome, UA classification, and other possible factors previously reported were evaluated. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.

Results

Sixty-three patients were enrolled (type 1, 22; type 2, 41). The clinical success rates of the primary UAE session were 90.9% (20/22) for type 1 and 61.0% (25/41) for type 2 (p?=?0.018). Univariate and multivariate analyses demonstrated that the only UA classification was significantly associated with primary UAE failure (p?=?0.033).

Conclusions

The UA classification is an independent predictive factor of the clinical success rate of the primary UAE session for PPH; thus, it is an intuitive and optimal predictor for interventional radiologists to decide whether additional therapy is necessary.

     

Usefulness of Pelvic Artery Embolization in Cesarean Section Compared with Vaginal Delivery in 176 Patients

PurposeTo evaluate the efficacy and safety of transcatheter arterial embolization of the pelvic arteries for the treatment of postpartum hemorrhage (PPH) associated with cesarean section compared with vaginal delivery.Materials and MethodsA retrospective analysis of 176 patients undergoing transcatheter arterial embolization of the pelvic arteries for PPH from January 2006 through August 2011 was conducted at two institutions. The mean patient age was 33.9 years (range, 24–46 years). Data including delivery details, hematology and coagulation results, embolization details, and clinical outcomes were collected. Technical success was defined as cessation of bleeding on angiography or angiographically successful embolization of the bleeding artery. Clinical success was defined as the obviation of repeated embolization or surgical intervention.ResultsThe technical success rate was 98.8% (n = 174), and the clinical success rate was 89.7% (n = 158). Among 176 patients, 71 had cesarean sections, and 105 underwent normal vaginal deliveries. Of the 105 patients who underwent normal vaginal deliveries, 11 (10.5%) required repeat embolization or surgical intervention. Of the 71 patients who had cesarean sections, 7 (9.8%) required repeat embolization or surgical intervention. The clinical success rate and complication rate were not related to the mode of delivery. All women resumed menses after transcatheter arterial embolization, and most (n = 125) described their menses as unchanged. Subsequent spontaneous pregnancies occurred in 13 women.ConclusionsThe cesarean mode of delivery is not a predictor of poorer outcomes of transcatheter arterial embolization; however, further study is needed to clarify this relationship.     

Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries

Objectives

To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries.

Methods

From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery.

Results

PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %.

Conclusions

PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity.

Key Points

? Endovascular treatment is a validated technique in post-partum haemorrhage. ? Abnormal placental implantation is a risk factor for post-partum haemorrhage. ? We propose an interventional radiologist standby in the delivery room.

     

Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization

The results of selective intraarterial vasopressin-infusion therapy and embolization therapy were compared in two groups of patients with major gastrointestinal hemorrhage. The site of bleeding, clinical course, complications, and transfusion requirements were evaluated in each group. Intraarterial vasopressin infusion therapy resulted in successful control of hemorrhage in 16 (70%) of 23 patients. Four patients, however, rebled and an operation was necessary, reducing the overall success rate to 52% (12 of 23). In the group treated with embolization therapy, primary success was achieved in 17 (71%) of 24 patients. Four patients in whom initial embolization failed to control bleeding underwent repeat embolization and in all four permanent control of hemorrhage was obtained, producing an overall success rate of 21 (88%) of 24. Analysis of our results according to site of hemorrhage suggests that at certain sites embolization is a preferred method of treatment; embolization allows earlier control of gastrointestinal hemorrhage and a reduction in transfusion requirements.     

Utilization and Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study

PurposeTo identify differences in mortality or length of hospital stay for mothers treated with uterine artery embolization (UAE) or hysterectomy for severe postpartum hemorrhage (PPH), as well as to analyze whether geographic or clinical determinants affected the type of therapy received.Materials and MethodsThis National Inpatient Sample study from 2005 to 2017 included all patients with live-birth deliveries. Severe PPH was defined as PPH that required transfusion, hysterectomy, or UAE. Propensity score weighting–adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay.ResultsOf 9.8 million identified live births, PPH occurred in 31.0 per 1,000 cases. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000 cases). The following factors predicted that hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension during pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all P < .001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included postterm pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all P < .001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (P < .001).ConclusionsDespite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.