Lara C. Pullen, PhD

April 06, 2011

April 6, 2011 (Chicago, Illinois) — An initial session of pelvic arterial embolization (PAE) is safe and effective in 86.2% of patients with postpartum hemorrhage.

Ji Hoon Shin, MD, associate professor, Radiology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, presented results of a study demonstrating these findings here at the Society of Interventional Radiology 36th Annual Scientific Meeting.

Dr. Shin noted that traditional surgical approaches for the treatment of postpartum hemorrhage often involve the loss of fertility, as well as the risk from general anesthesia. The purpose of the study was to evaluate the safety and efficacy of PAE for the treatment of primary postpartum hemorrhage (PPH), and to determine the factors associated with clinical outcomes.

The retrospective study involved 225 patients (mean age, 32 years) who underwent PAE for primary PPH between January 2000 and June 2010. Dr. Shin reported that PAE is a minimally invasive life-saving therapy that preserves patient quality of life and speeds recovery for patients with PPH.

With PAE, an interventional radiologist inserts a catheter into the femoral artery and, using real-time imaging, guides it into the arteries supplying the uterus, and then injects small particles that block the blood flow to the uterus and stop the bleeding.

Dr. Shin reported clinical success using PAE in 194 patients (86.2%). Clinical success was defined as cessation of bleeding after the intervention without the need for additional therapy or surgery. The clinical success rate increased to 89% with repeat PAE. PAE was most likely to have poor results in women undergoing cesarean section and in those with associated disseminated intravascular coagulation and a short interval from delivery.

PPH remains one of the major causes of maternal morbidity and mortality throughout the world. The most common cause of PPH is when the uterus does not contract strongly enough postpartum and blood vessels in the uterus bleed freely. Traditionally, hysterectomy has been the only solution to control the bleeding and arrestpostpartum hemorrhage in this setting.

In contrast to hysterectomy, PAE appears to allow some women to conceive again. However, Dr. Shin noted that although the results are promising, additional research needs to be done to explore the effect of the treatment on future fertility.

Ziv J. Haskal, MD, FSIR, FACR, FAHA, FCIRSE, chief of vascular and interventional radiology, University of Maryland Medical Center, Baltimore, Maryland, spoke with Medscape Medical News about the research and described it as the work of a very methodical researcher who has a fairly large collection of patients at one of the leading and modern institutions in the world.

Dr. Haskal noted that "it is still surprising how, even today, there are women who have life-threatening bleeding after delivery." If obstetricians can identify women who are at risk for certain placental findings 6 weeks before delivery, then interventional radiologists can be in place for the delivery, he said.

Dr. Haskal explained to Medscape Medical News that the significance of this study revolves around the fact that none of the women were preidentified as having placental complications. He sees this study as "a call to arms" to the obstetrician and family practitioner readers of Medscape Medical News to be aware that this sort of intervention from an interventional radiologist can stop bleeding.

He added that, in an ideal world, patients who are at risk for bleeding would be preidentified, which was not done in this study.

Dr. Shin and Dr. Haskal have disclosed no relevant financial relationships.

Society of Interventional Radiology (SIR) 2011 Annual Meeting: Abstract 214. Presented March 30, 2011.

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