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Is Selective Embolization of Uterine Arteries a Safe Alternative to Hysterectomy in Patients with Postpartum Hemorrhage?

Jean-François Deux1, Marc Bazot1, Alain Ferdinand Le Blanche1, Marc Tassart1, Antoine Khalil1, Nadia Berkane2, Serge Uzan2 and Frank Boudghène1

1 Service de Radiologie Hôpital Tenon, 20 Rue de la Chine, 75020 Paris, France.
2 Service de Gynécologie Obstétrique Hôpital Tenon, 75020 Paris, France.



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  		Fig. 1A. —34-year-old woman with postpartum hemorrhage resistant to medical treatment. Findings at manual exploration of uterine cavity were negative. Selective arteriogram of internal iliac artery shows opacification of vagina during contrast injection into internal iliac artery. Opacification is due to contrast extravasation from vaginal artery (single arrow). Note distal intramyometrial uterine vessels (double arrows) and obturator artery (arrowhead).

 


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  		Fig. 1B. —34-year-old woman with postpartum hemorrhage resistant to medical treatment. Findings at manual exploration of uterine cavity were negative. Selective arteriogram shows internal iliac artery after embolization of vaginal and uterine arteries. Blood extravasation is absent from vaginal artery (single arrow), and distal uterine vessels (double arrows) are devascularized. Note pledget of gelatin sponge (Gelfoam; Upjohn, Kalamazoo, MI) in obturatory artery (arrowhead), which did not induce any complication.

 

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