Modern view on uterine artery embolization in the therapy of hypotonic postpartum hemorrhage

Objective. To evaluate the efficacy and safety of uterine artery embolization in comparison with bilateral ligation of the internal iliac artery in hypotonic postpartum hemorrhage. Material and methods. 164 patients with hypotonic postpartum hemorrhage were examined: bilateral ligation of the internal iliac artery was performed in 50 women (group 1), and uterine artery embolization was performed in 114 women (group 2). Results. The initial volume of blood loss in hypotonic postpartum hemorrhage was less in group 1 than in group 2 (525 and 800 ml, respectively; p<0.05), the initial hemoglobin level was higher in group 1 than in group 2 (108.7±15.5 and 83.6±18.0 g/l, respectively; p<0.05). The duration of surgery and the volume of additional blood loss were longer in spontaneously delivered patients in group 1 (64±15 min and 1025 ml, respectively) than in group 2 (49.6±17.9 min and 75 ml; p≤0.001). Total blood loss was greater in group 1 than in group 2 for both hypotonic postpartum hemorrhages resulting from spontaneous delivery (2200 and 1800 ml, respectively; p=0.04) and caesarean section (1900 and 1600 ml, respectively; p=0.03). The effectiveness of the intervention (bilateral ligation of the internal iliac artery and uterine artery embolization) was similar in patients with hypotonic postpartum hemorrhage, both those who gave birth through vaginal delivery (93.8 and 98.8%, respectively) and by caesarean section (88.2 and 90.9%) (p>0.05). The ineffectiveness of surgery and the incidence of hysterectomy were higher in group 1 (10 and 10%, respectively) than in group 2 (3.5 and 0.9%, respectively; p<0.05). The postoperative period was without complications in 92 and 93% of women, respectively (p>0.05). Conclusion. Uterine artery embolization is the method of choice for surgical treatment of women with hypotonic postpartum hemorrhage in the availability of appropriate equipment and experience of the surgeon, who possesses X-ray endovascular interventions.