Journal List > Korean J Obstet Gynecol > v.53(9) > 1006466

So, Oh, Hwang, Hong, Cho, Oh, and Hur: Analysis of failed arterial embolization for postpartum hemorrhage



To investigate what factors are associated with a failed arterial embolization for postpartum hemorrhage (PPH) and to attempt to estimate efficacy of arterial embolization.


Between 2004 and 2008, 60 patients at Korea University Medical Cencter underwent arterial embolization to control obstetrical hemorrhage. In all cases, arterial embolization was performed because of intractable hemorrhage unresponsive to conservative management. Medical records and angiographic results were reviewed. Arterial embolization failure was defined as the requirement for subsequent surgical procedure to control PPH with the procedure, and its results.


Arterial embolization was attempted in 60 of deliveries. Failures occurred in 7 of 60 cases (11.7%) and in 4 of 7 cases (57.1%) of abnormal placentation (placenta previa totalis with or without placenta accrete or increta). Comparison of the failed and successful arterial embolization groups showed no differences in maternal characteristics, clinical status, and angiographic finding. Amount of total transfusion in failed arterial embolization group were larger than successful group although hemoglobin before embolization was not different.


The only factor significantly associated with failed arterial embolization was an abnormal placentation. Arterial embolization is a safe and highly effective method to control PPH.

Figures and Tables

Table 1
Characteristics of the patients undergoing arterial embolization

PPH: postpartum hemorrhage.

Table 2
Causes of postpartum hemorrhage


Table 3
Characteristics of failed arterial embolization

PPH: postpartum hemorrhage, BP: blood pressure, HR: heart rate, RBC: red blood cell, TAH: total abdominal hysterectomy, D&CB: dilatation and curettage.

*HR was unrecorded.

Table 4
Comparison of succeeded and failed arterial embolization (%)

D&CB: dilatation and curettage, SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate, RBC: red blood cell, ICU: intensive care unit.



1. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006. 367:1066–1074.
2. Mercier FJ, Van de Velde M. Major obstetric hemorrhage. Anesthesiol Clin. 2008. 26:53–66. vi.
3. Kang CS, Park SY, Lee JY, Oh JY, Ju WD, Kim SK, et al. Applicable indications and effectiveness of the selective arterial embolization in the management of obstetrical hemorrhage. Korean J Obstet Gynecol. 2004. 47:51–59.
4. Kwon JH, Kim GS. Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization. Radiographics. 2002. 22:35–46.
5. Shin WK, Kim DJ, Kim HM, Park SH, Jun HA, Lee KY. A case of angiography and transarterial embolization in arteriovenous malformation of uterus after a cesarean section episode. Korean J Obstet Gynecol. 2007. 50:801–806.
6. Oliver JA Jr, Lance JS. Selective embolization to control massive hemorrhage following pelvic surgery. Am J Obstet Gynecol. 1979. 135:431–432.
7. Heaston DK, Mineau DE, Brown BJ, Miller FJ Jr. Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR Am J Roentgenol. 1979. 133:152–154.
8. Chow TW, Nwosu EC, Gould DA, Richmond DH. Pregnancy following successful embolisation of a uterine vascular malformation. Br J Obstet Gynaecol. 1995. 102:166–168.
9. Shin SJ, Lee BS, Jeong CJ, Cho EJ, Cha DH, Lee K. A case taken total abdominal hysterectomy after failure of transarterial embolization in arteriovenous malformation of the uterus. Korean J Obstet Gynecol. 1993. 36:725–730.
10. Combs CA, Murphy EL, Laros RK Jr. Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol. 1991. 77:77–82.
11. ACOG educational bulletin. Postpartum hemorrhage. Postpartum hemorrhage. Number 243, January 1998 (replaces No. 143, July 1990). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1998. 61:79–86.
12. Combs CA, Murphy EL, Laros RK Jr. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991. 77:69–76.
13. Mason BA. Postpartum hemorrhage and arterial embolization. Curr Opin Obstet Gynecol. 1998. 10:475–479.
14. Gilbert WM, Moore TR, Resnik R, Doemeny J, Chin H, Bookstein JJ. Angiographic embolization in the management of hemorrhagic complications of pregnancy. Am J Obstet Gynecol. 1992. 166:493–497.
15. Bakri YN, Linjawi T. Angiographic embolization for control of pelvic genital tract hemorrhage. Report of 14 cases. Acta Obstet Gynecol Scand. 1992. 71:17–21.
16. Sieber PR. Bladder necrosis secondary to pelvic artery embolization: case report and literature review. J Urol. 1994. 151:422.
17. Greenwood LH, Glickman MG, Schwartz PE, Morse SS, Denny DF. Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization. Radiology. 1987. 164:155–159.
18. Hare WS, Holland CJ. Paresis following internal iliac artery embolization. Radiology. 1983. 146:47–51.
19. Pirard C, Squifflet J, Gilles A, Donnez J. Uterine necrosis and sepsis after vascular embolization and surgical ligation in a patient with postpartum hemorrhage. Fertil Steril. 2002. 78:412–413.
20. Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol. 2001. 177:145–149.
21. Zelop CM, Harlow BL, Frigoletto FD Jr, Safon LE, Saltzman DH. Emergency peripartum hysterectomy. Am J Obstet Gynecol. 1993. 168:1443–1448.
22. Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod. 2008. 23:1553–1559.
23. Kim JR, Cho YK, Kim HM, Choi EJ, Kim DW, Seo YS, et al. Angiographic findings and effect of superselective embolization for early and late postpartum bleeding. Korean J Obstet Gynecol. 2009. 52:44–52.
24. Harvey MP, Greenfield TP, Sugrue ME, Rosenfeld D. Massive blood transfusion in a tertiary referral hospital. Clinical outcomes and haemostatic complications. Med J Aust. 1995. 163:356–359.
25. Lee MK, Kim HO, Hong SG, Kwon OH, Kim JJ. Massive transfusion in Severance hospital. Korean J Blood Transfus. 1993. 4:23–28.
26. Sawyer PR, Harrison CR. Massive transfusion in adults. Diagnoses, survival and blood bank support. Vox Sang. 1990. 58:199–203.
27. Wilson RF, Dulchavsky SA, Soullier G, Beckman B. Problems with 20 or more blood transfusions in 24 hours. Am Surg. 1987. 53:410–417.
28. Leslie SD, Toy PT. Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid. Am J Clin Pathol. 1991. 96:770–773.
29. Kozhura VL, Novoderzhkina IS, Kirsanova AK. Acute and massive hemorrhage: mechanisms of compensation and damage. Anesteziol Reanimatol. 2002. 9–13.
30. Rosenthal DM, Colapinto R. Angiographic arterial embolization in the management of postoperative vaginal hemorrhage. Am J Obstet Gynecol. 1985. 151:227–231.
31. Poppe W, Van Assche FA, Wilms G, Favril A, Baert A. Pregnancy after transcatheter embolization of a uterine arteriovenous malformation. Am J Obstet Gynecol. 1987. 156:1179–1180.
32. Kim MJ, Park CH, Kwen I, Lee HJ, Hur SY, Kim EJ, et al. An uncommon cause of postpartum hemorrhage after cesarean section treated with selective arterial embolization: Pseudoaneurysm of the uterine pedicle. Korean J Obstet Gynecol. 2004. 47:2236–2240.
33. Lee JT, Jung HG, Park BD, Hur JS, Hwang JS, Lee DJ, et al. Failed two cases' analysis of eight Transarterial embolization therapy for Pseudoaneurysm followed by D&C. Korean J Obstet Gynecol. 2000. 43:1921–1925.
34. Mitchell DG, Needleman L, Bezzi M, Goldberg BB, Kurtz AB, Pennell RG, et al. Femoral artery pseudoaneurysm: diagnosis with conventional duplex and color Doppler US. Radiology. 1987. 165:687–690.
35. Soyer P, Fargeaudou Y, Morel O, Boudiaf M, Leq Dref O, Rymer R. Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur Radiol. 2008. 18:1181–1187.
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