Indications

• Post-Partum Hemorrhage

  • • Factors predicting high-risk for UAE: placenta accreta and other similar abnormalities, bleeding diathesis

    • Placement of intra-arterial balloon catheters to prevent hemorrhage

• Pre-op: prior to resection of uterine tumors to prevent blood loss

• Post-op: any uncontrolled bleeding after gynecologic surgery

• Uterine fibroids, adenomyosis, AVM (typically outpatient workup)

Contraindications

• Absolute:

  • • Viable pregnancy (although balloon catheters can be placed in prep)

    • Endometritis

    • Active infection

• Relative:

  • • Uncorrectable bleeding diathesis

    • Contrast allergy (premedicate, as time allows)

    • Renal impairment

    • Desire for future pregnancy (evidence under debate)

Imaging Review

• Typically not required in the setting of vaginal bleeding of known source

• Intra-abdominal bleeding after pelvic surgery may benefit from CTA

  • • Localize arterial territory for embolization.

    • Options for access? Radial is often utilized for nonurgent UAE, but may not be appropriate in the more acute setting.

Tips for Workup

• How unstable is the patient?

  • • Does the patient require Massive Transfusion / Anesthesia support?

    • Are they NPO for moderate sedation?

    • Is OB/GYN debating whether to take patient to the OR?

• Can coagulopathy be reversed? If not, arterial access sheath can be left in place after angio and removed by us the next day.

• Consent: Risk of non-target embolization, vessel injury, uterine ischemia/necrosis/sepsis, permanent amenorrhea, ovarian failure (0-3% under age 45, 20-40% over 45), contrast nephropathy, access site complications