Endovascular Management of Postpartum Haemorrhage Refractory to Hysterectomy

Wednesday, April 2, 2025

10:48 AM – 10:57 AM CT

Location: Music City Center, 204

Presenting Author(s)

Ujjwal Gorsi, MD

Additional Professor
Post Graduate Institute of Medical Education and Research,Chandigarh, India

Author/Co-author(s)

NY

Nishita Yadav, MBBS

Fellow
Post Graduate Institute of Medical Education and Research, India
HB

Harish Bhujade, MD

Assistant Professor
Institute Medical Education Research Chandigarh, India
NK

Naveen Kalra, MD

Professor
Post Graduate Institute of Medical Education and Research, India
MK

Mandeep Kang, MD

Professor
Post Graduate Institute of Medical Education and Research, India

Purpose:

To analyse the causes of PPH refractory to even hysterectomy and discuss role of endovascular management in such unusual cases.

Materials and Methods:

All PPH patients referred for endovascular management from January, 2021 to June,2024 to our department were retrospectively analysed and those patients with PPH refractory to emergency hysterectomy were included. Digital subtraction angiography(DSA) was done for them after informed consent. Endovascular assess was obtained through common femoral artery and diagnostic angiography was performed. After identifying the source of bleed , embolization was done using micro coils or glue and lipiodol mixture. The causes of refractory haemorrhage and technical and clinical success of endovascular management were analysed.

Results:

Out of 58 PPH patients referred, 9 cases of haemorrhage refractory to hysterectomy were encountered. Causes of refractory bleeding were uterine artery pseudoaneurysm (2), ovarian artery bleeding (3) , bleeding via uterine artery of ligated IIA filling retrogradely through collaterals (2) and bleeding via abnormal Internal iliac artery( (2). 6 cases were embolized using glue and lipiodol and 3 using coils. Technical and clinical success was achieved in all 9 cases. No major procedure related complication or mortality was encountered in this study.

Conclusion:

PPH is initially managed conservatively with resuscitation, medical management and mechanical methods followed by surgical management or endovascular management (e.g. UAE) and ultimately hysterectomy. Endovascular embolization can be life saving for treating unusual causes of PPH which fail to respond even to hysterectomy.