Interventional radiology in the management of uncommon causes of obstetric haemorrhage.

Purpose: To delineate the uncommon causes of pregnancy related haemorrhage and discuss various endovascular, and direct percutaneous interventional radiology techniques that can be used for successful management.

Materials And Methods: Forty-four females with uncommon causes of pregnancy related haemorrhage, who were referred for uterine artery embolization, between January 2013 and May 2020, were retrospectively analyzed in this hospital-based study. Observations were tabulated under age, prior procedure, post procedure day, underlying pathology, route, embolizing agent used, complications and recurrence, and statistical analysis done.

Results: The mean age of the studied population was 28.5 ± 4.9 years (range 20-41 years), and the most common prior procedure performed was caesarean section (31.8 %), followed by post abortive procedures (29.5 %) and normal vaginal deliveries (27.3 %). The median post procedure duration was 6.5 days (range 1-80 days). Most common underlying pathology was pseudoaneurysm (31.8 %), followed by arteriovenous malformations and uterine artery hypertrophy (18.2 % each). Percutaneous route was used in 6 patients while the remaining 38 patients underwent endovascular management. Overall, Gelfoam was used in 50 % patients, gelfoam plus another agent in 29.5 % and glue in 20.5 % patients. Technical success was achieved in 97.7 % and clinical success in 95.4 % with no major procedure related complications.

Conclusion: Interventional Radiology offers minimally invasive, safe and effective embolization procedures for the management of uncommon causes of pregnancy related haemorrhage, with low complication rate and high clinical success.