Treatment of arterial embolism haemorrhage

  Postpartum hemorrhage can be caused by weak uterine contractions, retained placenta-fetal membranes, soft birth canal lacerations and coagulation dysfunction. Postpartum hemorrhage is defined as bleeding more than 500mL after vaginal delivery or more than 1000mL after cesarean section within 24 hours after delivery of the fetus. The common conservative treatment is to perform uterine evacuation, massage the uterus, use high dose of contraction, and fill the uterine cavity with gauze while stopping bleeding and resuscitating shock by anti-infection. However, removal of the uterus may cause endocrine dysfunction and prevent future childbirth.  The basic principle of arterial embolization is to embolize the uterine artery, which is the main blood supply artery to the uterus, so that no blood can escape from the bleeding artery. The selectivity of embolization vascularity depends on the specific intraoperative situation, and the closer the embolization site is to the bleeding site, the better the effect and the less the side effects.  In our group, 10 cases were embolized by super-selecting the uterine artery, 1 case was embolized by embolization of the anterior internal iliac artery because of vasospasm, and 1 case was embolized by emergency embolization of the anterior internal iliac artery because of the patient’s tendency to go into shock. Do not prolong the operation time by forcing to superselect the uterine artery, because embolization of the anterior trunk of the internal iliac artery can achieve the same purpose of hemostasis without serious complications, because the pelvic organs have rich collateral circulation and anastomosis.  In the choice of embolic agent, we use gelatin sponge as the embolic agent. The gelatin sponge is first compressed and cut into granules of about 2 mm in size, mixed with contrast agent in the syringe and injected into the artery to be embolized under fluoroscopy. The gelatin sponge is insoluble in water, but it is degradable in the body and is a medium-term embolic substance, with a complete degradation time of 14-90 days. The symptoms disappeared with the establishment of collateral circulation and did not cause ischemia and necrosis of pelvic organs. Uterine artery embolization does not affect the patient’s postoperative menstrual recovery and reproductive function.  In conclusion, interventional arterial embolization for postpartum hemorrhage plays a very important role in the treatment of postpartum hemorrhage because it avoids the damage and possible complications caused by surgery, and has the advantages of safety and reliability, rapid hemostasis, high success rate, few complications, significant efficacy and preservation of uterine and reproductive functions.