Management of primary postpartum haemorrhage with arterial embolisation in Hong Kong public hospitals

SPY Yong, KB Cheung
Department of Obstetrics and Gynaecology, Tuen Mun Hospital, Tuen Mun, Hong Kong

OBJECTIVE. To assess the utilisation, effectiveness, and safety of arterial (angiographic) embolisation for management of severe primary postpartum haemorrhage in Hong Kong public hospitals.

DESIGN. Retrospective study.

SETTING. All eight obstetrics and gynaecology units of the Hospital Authority in Hong Kong.

PATIENTS. Women who underwent arterial embolisation for primary postpartum haemorrhage from July 1999 to June 2004 inclusive.

MAIN OUTCOME MEASURES. Cause of primary postpartum haemorrhage, estimated blood loss, patient condition before embolisation, and the intervals between the diagnosis of postpartum haemorrhage and the procedure.

RESULTS. Primary postpartum haemorrhage occurred in 7200 (3.9%) cases of 183 700 deliveries; 90 (0.05%) underwent total hysterectomy, whilst 29 (0.016%) received angiographic embolisation. Arterial embolisation was 90% effective in treating medically uncontrollable primary postpartum haemorrhage, except in three patients who failed to respond and underwent a hysterectomy. All 29 patients survived, although due to severe haemorrhage one had a cardiac arrest, whilst another had transient right-leg claudication. Six patients developed mild fever.

CONCLUSIONS. In Hong Kong, arterial embolisation for severe primary postpartum haemorrhage is a safe and effective treatment modality but is underutilised. If first-line medical treatment fails and patients are haemodynamically stable, the procedure should be considered an alternative management option. A prompt decision and early resort to arterial embolisation are advisable so as to reduce the morbidity and avoid resorting to open surgery.

Hong Kong Med J 2006;12:437-41

Key words: Embolization, therapeutic; Hemostatic techniques; Obstetric labor complications; Postpartum hemorrhage; Treatment outcome