Embolization of the hypogastric artery in postpartum haemorrhage

Selective embolization of the hypogastric artery is nowadays commonly used for the haemostasis of gynaecological cancer patients. Also re-embolization is possible in the cases of repeated bleedings. We present this method based on the summary of three obstetrical patients in our hospital. In these patients, primary management failed to control bleeding after parturition caused by anatomic reasons which made it difficult to access the bleeding and to achieve haemostasis. During intervention we catheterized the visceral branch of the internal iliac artery selectively via an access in the common femoral artery. Thereafter we blocked the artery with Spongostan fillings. We had one patient, where we applied embolization in retroperitoneal haemorrhage after Caesarean section and supravaginal amputation of the uterus. In two other cases we successfully managed vaginal haematoma by embolization, whereas multiple surgical treatments were unsuccessful. The advantage of this method is that it does not require laparotomy or vaginal exploration. The disadvantage is that a well-equipped laboratory of angiography and an interventional radiologist are also required.