Embolización selectiva como tratamiento de la hemorragia obstétrica

Objective

To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility.

Material and methods

We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility.

Results

Hemorrhage was classified as primary (25/27) or secondary (2/27).The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1).The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients).Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies.

Conclusion

Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility.