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Pelvic Artery Embolization in the Management of Obstetrical Hemorrhage: Predictive Factors for Clinical Outcomes

  • Clinical Investigation
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Abstract

Purpose

To evaluate clinical outcomes of pelvic artery embolization (PAE) for treatment of obstetric hemorrhage, and determine the predictive factors associated with failure.

Materials and Methods

This retrospective study included all consecutive patients who underwent PAE for obstetric hemorrhage (not only in the post-partum setting), between January 2003 and January 2013 at three tertiary care centers. Medical records and imaging were reviewed to identify the study population and collect data on patient characteristics, PAE characteristics, and outcomes. Multiple parameters were compared between the failed and successful PAE groups, and univariate analysis was performed to determine the predictive factors for PAE failure.

Results

A total of 74 PAE procedures were performed in 68 patients. Primary clinical success rate was 78 %. On univariate analysis, three factors were associated with PAE failure: hemodynamic instability (p < 0.022), hemoglobin level <95 g/dL (p < 0.024), and disseminated intravascular coagulation (DIC) (p < 0.046). Other factors, including maternal characteristics, antecedent history, angiographic finding, embolic agent, operator experience, procedure done after hours, and unilateral versus bilateral embolization, did not show any statistically significant association with PAE failure. Only one major complication was encountered, which was fetal demise in a pregnant patient with a uterine arteriovenous malformations. Out of the 68 patients, there were 61 total pregnancies at follow-up.

Conclusion

PAE is an effective treatment for obstetric hemorrhage, with a low complication rate, and preserves fertility. Factors significantly associated with PAE failure include hemodynamic instability, hemoglobin level <95 g/dL, and DIC.

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Acknowledgments

We would like to acknowledge the support of the interventional radiology department across our three hospitals, including the radiologists, nurses, technologists, and administrative department, especially Tracey Clare (Research coordinator, University of Alberta Diagnostic Imaging), and Linda O’Hara (Manager of Diagnostic Imaging at University of Alberta Hospital). No grant was utilized for this research.

Conflict of interest

Dr. Edwin Zhang: No potential conflict of interest to declare; Mr. Lizhi Liu: No potential conflict of interest to declare; Dr. Richard Owen: No potential conflict of interest to declare.

Informed consent

Our study protocol was approved by our institutional review board, and informed consent was waived.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada

    E. Zhang & R. Owen

  2. Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada

    L. Liu

Authors
  1. E. Zhang
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  2. L. Liu
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  3. R. Owen
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Corresponding author

Correspondence to R. Owen.

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Zhang, E., Liu, L. & Owen, R. Pelvic Artery Embolization in the Management of Obstetrical Hemorrhage: Predictive Factors for Clinical Outcomes. Cardiovasc Intervent Radiol 38, 1477–1486 (2015). https://doi.org/10.1007/s00270-015-1092-5

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  • DOI: https://doi.org/10.1007/s00270-015-1092-5

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