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Massive Obstetrical Bleeding

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Uterine Artery Embolization

Uterine artery embolization is an infrequently used technique which has been reported to have a very high success rate in the management of massive obstetric haemorrhage.16 Its usefulness was highlighted in the latest CEMACH report1 and the prophylactic preoperative placement of embolization catheters in women at very high risk of severe bleeding at elective Caesarean Section, such as those with placenta accreta, has been suggested.2 The technique involves cannulating the femoral artery and then performing an angiogram to identify the bleeding point. Coaxial catheters are then fed up to the bleeding

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point or to the uterine arteries if no bleeding points can be identified. Embolization is then performed with polyvinyl alcohol particles (long-term embolizer) and gelatin sponge foam pieces (Gelfoam® short-term embolizer) or microcoils. Repeat angiograms can then demonstrate whether or not the technique has been successful.17

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