Complications and failure of uterine artery embolisation for intractable postpartum haemorrhage

• Published in: BJOG : an international journal of obstetrics and gynaecology 2009-01, Vol.116 (1), p.55-61
• Main Authors: Maassen, MS, Lambers, MDA, Tutein Nolthenius, RP, van der Valk, PHM, Elgersma, OE
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Case studies; Complications; Contrast Media - adverse effects; failure; Female; Gelatin Sponge, Absorbable - adverse effects; Gynecology. Andrology. Obstetrics; Hemorrhage; Humans; Hysterectomy - adverse effects; Iliac Artery; Leg - blood supply; Medical sciences; Medical treatment; postpartum haemorrhage; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - surgery; Postpartum period; Pregnancy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Reoperation - adverse effects; Reproductive system; Retreatment; Retrospective Studies; Treatment Outcome; uterine artery embolisation; Uterine Artery Embolization - adverse effects; Uterus - blood supply; Veins & arteries; Venous Thromboembolism - etiology; Vesicovaginal Fistula - etiology
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2008.01939.x

Objective  Primary postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality around the world. Most patients can be managed conservatively, but patients with intractable bleeding require more aggressive treatment. In these cases uterine artery embolisation (UAE) has proven to be a useful tool to control PPH. The reported success rate of UAE is over 90% with only minor complications. In this case series we studied the effectiveness and complications of UAE. Design  Retrospective analysis of a case series. Setting  Case series in a large peripheral hospital in the Netherlands. Sample  Eleven patients who were treated with UAE for intractable PPH from November 2004 to February 2008. Methods  In this paper we review the results of all patients treated with UAE for intractable PPH in our hospital and focus on the two cases with adverse outcomes. Main outcome measures  Effectiveness, causes of failure of UAE, complications. Results  Nine out of eleven patients were treated successfully with UAE. One patient needed an emergency hysterectomy for intractable bleeding. In the aftermath she developed a vesicovaginal fistula (VVF). Another patient suffered a major thrombo‐embolic event of the right leg, for which she underwent embolectomies and despite fasciotomy a necrotectomy. Conclusions  UAE is a valuable tool in managing major PPH and in most cases it can replace surgery and thus prevent sacrification of the uterus. However, due to blood supply of the uterus by one of the ovarian or aberrant arteries, UAE might fail to control the bleeding. In addition, serious complications such as a thrombo‐embolic event or VVF may occur. We hereby present a case of migration of an embolus from the site of re‐embolisation into the femoral artery requiring immediate intervention to prevent the loss of the lower leg. This complication demonstrates that gelatine sponge particles could migrate from the internal iliac artery into the external iliac artery.