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)
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)
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.
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