Assistant Professor of Interventional Radiology, Iran University of Medical Science
Postpartum hemorrhage is the most serious complication encountered by obstetricians during routine patient care and is the leading cause of severe maternal morbidity and death. The incidence of maternal mortality due to postpartum bleeding varies between countries. In developing countries, the incidence of maternal mortality is approximately 1 in 1,000 deliveries, whereas in developed countries, the incidence is only around 1 in 10,0000 deliveries / This large difference in maternal mortality is primarily attributed to country-specific differences in management capacity. Recommended procedures for management of postpartum hemorrhage have been well published, with recent reports focusing on use of conservative management rather than cesarean hysterectomy (CH) to preserve the uterus.
The first step in common management of postpartum hemorrhage is the use of uterine stimulants (uterotonics) such as oxytocin, ergot derivatives, prostaglandins, and misoprostol, and bimanual compression of the uterus. Recommended operative procedures for the management of postpartum hemorrhage include surgical repair of lower genital tract lacerations, uterine hypogastric artery ligation, and hysterectomy.
More recently, the relative benefits of uterine artery embolization (UAE) versus CH have been debated. UAE is generally accepted to be a safe and reliable procedure; however, the success rates and complications for this procedure have been published, and these presented only a small number of cases. Primary postpartum hemorrhage occurs within the first 24 hours following delivery. We estimate critical patient characteristics influencing the success of UAE for the treatment of emergent primary postpartum hemorrhage.
the purpose of intervention is to preserve the mother’s life and not to rescue the uterus. In developed countries, UAE has been utilized as an alternative method for management of intractable bleeding following failure of medical management, and uterine artery pseudoaneurysm or arteriovenous malformation.