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Uterine Artery Embolization (Postpartum Hemorrhage)

Life-saving endovascular intervention: uterus-sparing alternative to hysterectomy

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Uterine Artery Embolization (Postpartum Hemorrhage)?

Postpartum hemorrhage is the leading cause of maternal mortality (>500 mL after vaginal delivery, >1000 mL after cesarean section); 6-10% incidence. The 4 T's (tone-uterine atony, trauma, tissue-retained products, thrombin-coagulopathy) are the etiologic factors. UAE is a critical option after failed initial bleeding control (uterotonics, balloon tamponade).

Technique: under fluoroscopic guidance, common femoral artery access with 5 Fr Cobra/Roberts catheter is used to selectively catheterize bilateral uterine arteries; embolization is performed with absorbable Gelfoam pieces (1-2 mm), microspheres, or coils. The procedure typically takes 30-60 minutes; uterus is preserved.

Indications: atonic PPH refractory to medical therapy, accreta-increta-percreta (especially elective preoperative occlusion balloon), traumatic vaginal/uterine laceration, retained products (post-curettage), uterine arteriovenous malformation. Success rate 90-95%; 5-10% require hysterectomy. Future fertility is generally preserved (60-80% pregnancy rate).

Symptoms

Active bleeding after vaginal delivery (>500 mL/hour)
Uterine atony (impalpable, soft uterus)
Hemodynamic instability (tachycardia, hypotension)
Bleeding refractory to medical therapy (oxytocin, methylergonovine, carboprost)
Hemoglobin drop (>2 g/dL after delivery)
Uterus-preserving treatment desire

Risk Factors

Multiple pregnancy
Polyhydramnios
Macrosomia
Prolonged labor (>24 hours)
Previous cesarean section history
Placenta previa or accreta history

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent uterine atony
  • Bleeding refractory to medical therapy
  • Continuing severe bleeding despite balloon tamponade (Bakri)
  • Uterus-preserving treatment desire (future fertility)
  • Placenta accreta diagnosis (preoperative consultation)
  • Uterine arteriovenous malformation

Treatment Methods

01
Bilateral uterine artery selective embolization
02
Gelfoam (absorbable, 1-2 mm) - first preference
03
Microspheres (300-700 µm) or coils (selective)
04
Hemodynamic stabilization (transfusion, fluid)
05
Postembolization antibiotic (cefazolin)
06
Long-term follow-up (Asherman risk, future pregnancy planning)

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.