Pelvic Artery Embolization for Treatment of Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is the leading cause of maternal perinatal morbidity and mortality worldwide. Defined as greater than 500 mL blood loss after vaginal delivery, and greater than 1,000 mL blood loss after cesarean delivery, PPH has many causes, including uterine atony, lower genital tract lacerations, coagulopathy, and placental anomalies. Correction of coagulopathy and identification of the cause of bleeding are mainstays of treatment. Medical therapies such as uterotonics, balloon tamponade, pelvic artery embolization, and uterine-sparing surgical options are available. Hysterectomy is performed when conservative therapies fail. Pelvic artery embolization is safe and effective, and is the first-line therapy for medically refractory PPH. A thorough knowledge of pelvic arterial anatomy is critical. Recognition of variant anatomy can prevent therapeutic failure. Pelvic embolization is minimally invasive, has a low complication rate, spares the uterus, and preserves fertility.

The Belarus Experience of Pelvic Artery Embolisation in Patients with Advanced and Recurrent Cervical Cancer Presenting with Haemorrhage

To determine the efficacy of pelvic artery embolisation (PAE) in patients with locally advanced and recurrent cervical cancer (CC) complicated by haemorrhage, a retrospective study was performed of 81 patients with locally advanced or recurrent CC who underwent PAE for haemorrhage. Of the 81 patients included in the study, 68 (84%) had primary locally advanced CC and 13 (16%) had recurrent disease. Distribution of patients with primary disease according to the International Federation of Gynecology and Obstetrics (FIGO) stages was: IIB (n=4, 6%), IIIB (n=44, 65%), IV (n=20, 29%). The PAE controlled the haemorrhage in 76 patients (94%). After successful embolisation, 46 of 68 (68%) patients with primary CC started antineoplastic treatment a median of 3 days (range 1–17 days) after treatment. Twenty-nine of these women (43%) subsequently completed primary treatment for their disease. During the follow-up period, 67 patients (83%) died of disease and 4 (5%) died of other causes. The adjusted 1-year survival was 41.4% (standard error [SE] 5.6%), 5-year survival was 17.9% (SE 4.5%), and median adjusted survival was 8.4 months. Survival of the 22 patients (32%) who did not receive further treatment and 46 patients (68%) who continued the treatment was significantly different, with a 1-year adjusted survival of 15.2% (SE 8.1%) and 53.5% (SE 7.4%) respectively. None of the patients who did not receive further treatment survived 5 years, whereas in the group undergoing further treatment, the 5-year adjusted survival was 24.0% (SE 6.8%) and the median adjusted survival was 5.4 months and 12.8 months, respectively (p<0.001). Pelvic artery embolisation was effective in controlling haemorrhage in 94% of patients with locally advanced and recurrent CC. Sixty-eight percent of patients were able to undergo further antitumor treatment. Pelvic artery embolisation is a minimally invasive intervention that can be effective at any stage of treatment in patients with CC presenting with haemorrhage.