CIO 2022-12 Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage: A Single-Center Experience in India

Purpose: To evaluate the clinical effectiveness and safety of uterine artery embolization (UAE) in the treatment of patients with primary postpartum hemorrhage (PPH), secondary PPH, and PPH associated with cesarean section.

Materials and Methods: This prospective single-center study was institutional review board approved, and informed consent was waived. Outcomes were analyzed in 502 patients who underwent UAE for primary PPH between January 2012 and January 2022. The 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 UAE without the need for additional UAE or surgery. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.

Results: The clinical success rate was 91.8% (460 of 502). Among the 42 failed cases, 21 underwent repeat PAE, 18 underwent additional surgery, and 3 recovered with conservative management. Overall bleeding control was achieved in 97.0% (487 of 502) of the patients. The overall mortality rate was 1.8% (9 of 502) after the first (n = 3) or second (n = 1) session of UAE or additional surgery (n = 1). Among the 226 patients with long-term follow-up, 220 maintained a regular menstrual cycle, and 16 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 UAE. Multivariate analysis showed that DIC (odds ratio [OR], 0.35; P = 0.03) and massive transfusion (OR, 0.11; P < 0.001) were significantly related to clinical failure.

Conclusions: UAE is safe and effective for managing primary PPH. Patients with DIC and massive transfusion are likely to have poor results after UAE.