The role of uterine artery embolization in the treatment of late postpartum hemorrhage


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Abstract

Objective: To investigate the characteristic features of late postpartum hemorrhage that required endovascular intervention. Materials and methods: This is a retrospective analysis of medical records of 31 patients who were treated between 2006 to 2022. Inclusion criteria were late postpartum hemorrhage (24 h-42 days after delivery) and the use of uterine artery embolization (UAE). Results: Bleeding started on day 8 (6;14) postpartum, including 20/31 (64.5%) on days 2-10, 9/31 (29%) on days 12-21, and 2/31 (6.5%) on days 35-38. Twenty-three of the 31 (74.2%) patients (subgroup I) underwent uterine vacuum aspiration. Continued blood loss of1000 (600;1350) ml after vacuum aspiration was an indication for UAE. Surgical hemostasis was performed in 1/23 (4.3%) patients after UAE. A complicated course of the postoperative period was observed in 4/23(17.4%) patients. In 8/31 (25.8%) patients (subgroup II), UAE was performed in the first stage with an initial blood loss of650 (400;2000) ml. The postpartum period was uneventful and the patients were discharged on the fourth day. Conclusion: Massive late postpartum hemorrhage is rare. UAE is effective in stopping late postpartum hemorrhage in the absence of residual placental tissue in the uterine cavity established by echography.

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About the authors

Irina Yu. Breslav

MD GROUP Clinical Hospital, MD PROJECT

Email: irina_breslav@mail.ru
Dr. Med. Sci., Head of the Department of Obstetric Pathology of Pregnancy

Marina L. Kolotilova

I.M. Sechenov First Moscow State Medical University of Ministry of Health of Russia (Sechenov University)

Email: kolotilovaml@hotmail.com
Dr. Med. Sci., Professor at the Human Pathology Department, Institute of Biodesign and Modeling of Complex Systems

Ashot M. Grigoryan

Lapino Hospital

Email: a.grigoryan@mcclinics.ru
PhD, Head of the Interventional Cardiology Department

Olga P. Barykina

MD GROUP Clinical Hospital, MD PROJECT

Email: medslovar@mail.ru
pathologist, Head of the Department of Anatomic Pathology

Nikolay V. Skryabin

MD GROUP Clinical Hospital, MD PROJECT

Email: hranitelkr@mail.ru
Pathologist at the Department of Anatomic Pathology

Ekaterina A. Gaponenko

MD GROUP Clinical Hospital, MD PROJECT

Email: gaponenko.m.d@gmail.com
MD, Diagnostic Medical Sonographer

Elina R. Nigmatullina

MD GROUP Clinical Hospital, MD PROJECT; Bashkir State Medical University

Email: elinanig@mail.ru
Resident at the Department of Obstetrics and Gynecology, Faculty of General Medicine

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