Uterine artery embolization: Saving a mother and her motherhood

KS. Bharath*

Consultant Interventional Radiologist, Kauvery Hospital, Electronic city, Bengaluru, India

Background

Post-partum haemorrhage (PPH) is a dreaded complication of pregnancy. Maternal mortality is one of the crucial parameters of healthcare planning in our country. This condition is most commonly managed by hysterectomy wherein the bleeding uterus is removed to save the life of the mother. In this article we present a case of PPH where we could save the uterus along with the life of mother by a co-ordinated multispeciality management involving gynaecology and interventional radiology expertise.

Case Presentation

A young adult female (Para 2 living 2) presented to emergency ward at Kauvery Hospital, Bengaluru with c/o of bleeding PV and abdominal pain. She had undergone an LSCS a week back. Post-surgery, after going home the bleeding had slowly escalated and forced her back to the hospital. Her blood pressure was 100/70 mmHg and her vitals were otherwise stable. On evaluation her haemoglobin had dropped from 12 to 7 g/dl. USG and MRI showed blood clots of varied ages within the uterine cavity. A diagnosis of secondary Post partum haemorrhage was made.

The collected clots within the uterus had a risk to get infected and cause sepsis. At the same time there was fear about uterine clot evacuation which would take off the tamponade effect and precipitate an uncontrolled bleeding crisis.

Only option left out was hysterectomy which was unfortunate considering her young age and the trauma of putting her through a second surgery within a span of one week. However, since the hospital had the expertise and a setup to carry out an interventional radiological procedure, a hybrid management involving interventional radiologist and gynaecologist was planned.

Accordingly, the patient was taken to Cath lab. At first, both uterine arteries were embolised. With the catheter still in place in one of the uterine arteries, evacuation of the intrauterine bleed under ultrasound guidance on the same table was done. Post evacuation, angiogram of both uterine arteries was done which showed no contrast leak. No fresh bleed was seen per vagina on table. The patient fully recovered and was discharged soon with her life and uterus intact.

Dr. KS. Bharath,

Consultant Interventional Radiologist

Uterine artery embolization: Saving a mother and her motherhood