[Management of severe post-partum hemorrhage using selective arterial embolization]. / Prise en charge des hémorragies graves du post-partum par embolisation artérielle sélective.

OBJECTIVES: To evaluate the efficacy and safety of uterine embolization in the management of intractable post-partum hemorrhage. MATERIALS AND METHODS: From July 1994 to December 1997, 51 patients with severe primary (n = 37) or secondary (n = 14) post-partum hemorrhage were treated by arterial uterine embolization. In all cases, hemostatic uterine embolization was performed because of persistent hemorrhage despite adapted obstetrical measures and early introduction of uterotonic drugs. RESULTS: In case of immediate post-partum hemorrhage, primary and secondary success rates were 89% et 97% respectively. In one patient with placenta accreta, delayed hysterectomy was necessary. One patient died of associated cerebral hemorrhage while vaginal bleeding had stopped. The success rate reached 100% in case of secondary post-partum hemorrhage. CONCLUSION: Emergency arterial embolization is a safe and effective means of controlling severe post-partum hemorrhage after failure with medical treatment.