Brief Article
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World J Obstet Gynecol. Nov 10, 2013; 2(4): 185-191
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.185
Pelvic arterial embolization in obstetric hemorrhage
Vidhi Chaudhary, Poonam Sachdeva, Raksha Arora, Devender Kumar, Priya Karanth
Vidhi Chaudhary, Poonam Sachdeva, Raksha Arora, Devender Kumar, Priya Karanth, Department of Obstetrics and Gynecology, Maulana Azad Medical College and associated Lok Nayak Hospital and GB Pant Hospital, New Delhi 110002, India
Author contributions: Chaudhary V designed study and wrote the manuscript; Arora R, Sachdeva P, Kumar D, Chaudhary V and Karanth P were involved in medical, surgical and conservative management of patients and helped in editing of article; Chaudhary V and Karanth P collected all the data including follow up of the patients and searched articles to support this work.
Correspondence to: Dr. Vidhi Chaudhary, Senior Resident, Department of Obstetrics and Gynecology, Maulana Azad Medical college and Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi 110002, India. dr_vidh@yahoo.co.in
Telephone: +91-11-23239271
Received: April 29, 2013
Revised: July 3, 2013
Accepted: July 17, 2013
Published online: November 10, 2013
Processing time: 201 Days and 22.8 Hours
Abstract

AIM: To analyze safety and efficacy of pelvic arterial embolization (PAE) in preventing and treating obstetrical hemorrhage.

METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.

RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception.

CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.

Keywords: Pelvic artery embolization; Uterine artery embolization; Obstetric hemorrhage; Placenta accreta; Post partum hemorrhage

Core tip: Historically obstetric hysterectomy was definitive treatment in morbid adherent placenta, cervical ectopic pregnancy and post partum hemorrhage refractory to medical and conservative surgical measures. Emergence of Pelvic arterial embolization as a minimally invasive procedure had led to alternative use of use of embolizing agents in controlling significant hemorrhage in various etiologies of obstetric hemorrhage thereby conserving fertility and reducing maternal mortality and morbidity. We used P- particle and coil as embolizing material with 75% success in our series. Our study further strengthens our confidence in pelvic artery embolization for its applicability in managing obstetric hemorrhage.