ARRS 2022 Abstracts


E1279. Postpartum Hemorrhage at Subsequent Pregnancy in Women With a History of Uterine Artery Embolization
  1. Chang Jin Yoon; Seoul National University Bundang Hospital
  2. Jae Hwan Lee; Seoul National University Bundang Hospital
  3. Won Seok Choi; Seoul National University Bundang Hospital
  4. Chong-ho Lee; Seoul National University Bundang Hospital
The objective of this study was to evaluate angiographic findings and outcomes of uterine artery embolization (UAE) for recurrent severe postpartum hemorrhage (PPH) at subsequent pregnancy in women with a history of UAE.

Materials and Methods:
Between October 2003 and July 2021, UAE with gelatin sponge slurry was performed for PPH in 753 women. Of these, 13 women underwent repeat UAE for recurrent severe PPH after subsequent delivery. The causes of PPH, angiographic findings, hemostasis, and complications of the repeat procedures were evaluated.

The causes of PPH were retained placenta tissue (n = 7), uterine atony (n = 5), and pseudoaneurysm (n = 1). On angiogram, both uterine arteries were obliterated due to previous UAE in seven women (53.8%). The collateral uterus-supplying vessels were embolized (hypogastric [n = 7], round ligament [n = 3], ovarian [n = 2] artery). In the remaining five women with a patent uterine artery, both uterine arteries were embolized. Immediate hemostasis was achieved in eight women (61.5%). The remaining five women (38.5%) with an obliterated (n = 4) or patent (n = 1) uterine artery required hysterectomy (n = 4) and repeat UAE (n = 1). There were no major complications.

UAE with gelatin sponge slurry frequently causes placental abnormality and permanent uterine artery obliteration (53.8%). In recurrent PPH occurring at subsequent pregnancy, embolization of collateral uterus-supplying vessels frequently failed to achieve hemostasis (38.5%). The use of embolic material for recanalization of embolized uterine artery is needed.