The purpose of this investigation is to review the types of postpartum vascular injuries associated with caesarian section surgery and to review the techniques and outcomes of endovascular treatment.
Materials & Methods
This is a retrospective review of women who underwent endovascular treatment for vascular complications following C-section delivery at a single institution from 1/1/05 to 10/1/08. All imaging was reviewed along with clinical parameters, including patient age, prior pelvic surgery, time of presentation after C-section, type of vascular injury, type of endovascular treatment, and post-endovascular treatment clinical course.
Results
Thirteen women underwent endovascular treatment for postpartum hemorrhage following C-section during the time period specified. Mean age was 35.3 years old (range 28-44). Severity of bleeding ranged from mild (<500cc) to severe hemorrhage (>3000cc). Mean pre-embolization transfusion requirement was 3.2 units PRBC's (range 0-6). Five subjects had positive angiographic findings, including two pseudoaneurysms and three active arterial extravasations; in the remaining 8 subjects, no arterial bleed was found and prophylactic uterine artery embolization was performed to control presumed venous bleeding or vasospasm masking arterial bleeding. Onset of postpartum hemorrhage ranged from immediate to 16 days post C-section, with 9 of the 13 (69%) women presenting within 24 hours; however, both pseudoaneurysms presented after one week. Embolization agent choice included one hypogastric artery balloon occlusion, 2 coil embolizations, and 10 gelfoam embolizations. Mean post-embolization transfusion requirement was 0.45 units PRBC's (range 0-4) and mean length of stay after embolization was 5.2 days (range 1-12 days).
Conclusion
Vascular injury during caesarian section delivery is an uncommon event that can result in significant bleeding, presenting immediately or up to several weeks after delivery. Pseudoaneurysms in particular tend to have a delayed time of presentation. Overall, regardless of clinical circumstances, hemorrhage following C-section can be embolized promptly and effectively with minimal post-embolization complications.
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