Uterine artery embolization versus surgical management in primary atonic postpartum hemorrhage: A randomized clinical trial

BackgroundPostpartum hemorrhage is the leading cause of severe maternal morbidity and death. A prompt management of uterine atony is life saving. Surgery can be needed in many cases. Uterine artery embolization (UAE) is a safe procedure and can be tried to be alternative to surgical approach.ObjectiveTo evaluate the clinical effectiveness and safety of uterine artery embolization (UAE) in comparison with stepwise devascularization and compression sutures in the treatment of postpartum hemorrhage (PPH).MethodsRandomized controlled parallel-group trial included twenty-three women with postpartum hemorrhage who were treated with either selective embolization of the uterine arteries or stepwise devascularization and compression sutures after failure of conservative measures.ResultsTechnical success was achieved in 9 patients (81.8%) of cases with complete cessation of the bleeding, while 2 cases (18.2%) suffered DIC and needed hysterectomy in the UAE group, while the other group (12 patients) had stepwise devascularization and compression sutures done after failure of the conservative measures, with 3 cases who needed hysterectomy after failure of these methods.ConclusionsUterine artery embolization is a safe, minimally invasive and effective method for treatment of postpartum hemorrhage and is alternative to surgical management.