Uterine artery embolization for postpartum hemorrhage.

A new angiographic approach for the treatment of postpartum hemorrhage has emerged over the last 30 years. Uterine arterial embolization under fluoroscopic guidance is effective but requires that experienced personnel and facilities for interventional vascular radiology are available at the hospital or close by. Interventional radiology can be used as an elective, prophylactic measure in a known or suspected case of placenta accreta for which extirpative management is planned. There are no randomized controlled trials, but several systematic reviews have reported high rates of success in hemostatic control of the pelvis. Embolization was also effective when utilized early as an adjunct in the conservative treatment of placenta accreta, leaving the entire placenta or just the adherent portion in situ as an alternative to radical management. In patients who are hemorrhaging, the initial intervention is resuscitation and stabilization. After vaginal delivery, massage, uterotonic drugs, cavity and soft tissue examination, bimanual compression, and tamponade of the uterus should be tried first. Arterial embolization can be performed before laparotomy if the woman is stable; it can also be performed during a cesarean section procedure, after compressive sutures, and if stepwise uterine devascularization fails.