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Uterine Necrosis After Arterial Embolization for Postpartum Hemorrhage

Cottier, J. P. MD; Fignon, A. MD; Tranquart, F. MD, PhD; Herbreteau, D. MD

Case Reports

BACKGROUND: Selective embolization is an effective and reputedly safe method of managing pregnancy-related bleeding. However, we report an ischemic uterine necrosis after arterial embolization.

CASE: The patient had heavy postpartum bleeding treated by embolization of the uterine arteries using polyvinyl alcohol particles (diameter 150–250 and 300–600 μm) and gelatin sponge pledgets. Her postoperative recovery was complicated by menorrhagia and pelvic pain. Because of the persistent menorrhagia and risk of infection, a hysterectomy was performed. Histopathology of the hysterectomy specimen revealed massive ischemic myometrial necrosis.

CONCLUSION: This complication is most likely related to the small size of the particles used. In the management of postpartum bleeding by arterial embolization, the material of choice is gelatin sponge pledgets, and the use of small particles should be avoided.

In the management of postpartum bleeding by arterial embolization, the use of particles of a small size must be avoided to prevent ischemic uterine necrosis.

Department of Neuroradiology and Obstetrics and Gynecology, Hôpital Bretonneau, Tours, France

Address reprint requests to: J. P. Cottier, MD, Hôpital Bretonneau, Service de Neuroradiologie, 2 Boulevard Tonnellé, 37044 Tours Cedex 1, France; E-mail: cottier@med.univ-tours.fr.

The authors wish to thank Dr. Thierry Lefrancq for his histopathologic study.

Received December 28, 2001. Received in revised form February 28, 2002. Accepted March 14, 2002.

© 2002 The American College of Obstetricians and Gynecologists