Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome

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Abstract
32 patients with uncontrollable genital bleeding resulting from postpartum haemorrhage (n = 15) or malignant neoplasms (n = 17) were treated by arterial embolization therapy on an emergency basis. The 15 patients with postpartum haemorrhage responded dramatically to treatment by embolization. Follow-up computed tomography or magnetic resonance studies in 12 cases showed haematomas in the pelvic extraperitoneal space, but most then reduced in size or disappeared spontaneously. In two patients with large haematomas, laparotomy was required. No serious complications developed and normal menstruation resumed in the women who did not undergo hysterectomy. In the 17 patients with malignant neoplasms, bleeding was temporally controlled in all, but recurred in seven and required re-embolization in three. One patient experienced slight numbness of the leg and another had a skin ulcer. All patients underwent subsequent treatment including radiation therapy (n = 10), operation (n = 5) or chemotherapy (n = 2). We conclude that arterial embolization has significant merits in the management of patients with uncontrollable genital bleeding.