📖 Overview
Post-partum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. When uterotonics and surgical manoeuvres fail to control bleeding, uterine artery embolization (UAE) is the technique of choice to achieve haemostasis while preserving the uterus. Cochin AP-HP provides 24/7 emergency interventional radiology for this and other obstetric/pelvic haemorrhage scenarios.
UAE for PPH has a success rate of 85–92% in controlling haemorrhage, with uterus preservation in most cases. Future pregnancies are possible in the majority of patients.
🎯 Indications
- Post-partum haemorrhage refractory to uterotonics (oxytocin, carbetocin, prostaglandins) and uterine massage
- PPH after caesarean section — including placenta accreta/increta/percreta
- Pelvic fracture with haemodynamically significant arterial bleeding
- Post-surgical pelvic haemorrhage (gynaecological, urological, colorectal surgery)
- Haemorrhage from uterine fibroids or AVM
🔧 Procedure
IR team activated by obstetrics/emergency team. Patient transferred to angiography suite — directly from delivery suite or ICU.
Bilateral femoral access in most cases. Simultaneous catheterisation of both uterine arteries.
Pelvic angiography to identify bleeding source. Selective uterine artery embolization with Gelfoam particles (resorbable) or coils. Procedure time: 20–40 minutes.
Intensive care monitoring as required. Clinical assessment at 2 and 24 hours. UAE does not preclude further surgery if required.