Transcatheter Arterial Embolization for Treating Intractable Post - Partum Hemorrhage : early success indicators

Reprint requests to: Dr. Li-Jen Wang Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital. No. 5, Fu Hsing Street, Gueishan, Taoyuan 333, Taiwan, R.O.C. Transcatheter arterial embolization (TAE) is an effective alternative treatment for intractable postpartum hemorrhage (PPH). However, when initial TAE failed, further treatment was often delayed because there were no early indicators for TAE success. This study aimed to identify early indicators of the outcome of TAE for PPH. From December 2003 to July 2006, 20 consecutive patients underwent TAE for uncontrollable PPH in our hospital. TAE outcomes were categorised into success and failure groups. Success was defined as a patient survived PPH after TAE without requiring further any intervention or surgical procedure. We analyzed the association of successful TAE outcome with demographic features, clinical characteristics, TAE response time, angiographic findings, vital signs and hemogram. The changes in vital signs and hemograms in each outcome group (success or failure) before and after TAE were also analyzed Seventeen (85%) pat ient s had successfu l outcomes after TAE. Age, clinical characteristics, TAE response time and angiographic f indings had no significant difference between the success and fai lure groups. There was a signi f icant difference of post-TAE systolic blood pressure of greater than or equal to 90mmHg between success and failure groups (16 of 17 versus 1 of 3, respectively, p = 0.007). The differences of body temperature (p = 0.036) and heart rate (p = 0.008) before and after TAE were also significantly different between both groups. TAE is usual ly ef fect ive for treat ing PPH. Patients who had a systolic blood pressure less than 90 mmHg, low body temperature or rapid heart rate after TAE should be evaluated for the need of further intervention or surgery as soon as possible to stop the ongoing blood loss and avoid associated morbidity and mortality.