This article describes the role of endovascular treatment in the management of obstetrical and gynecologic emergencies. Interventional techniques for obstetrical and gynecologic emergencies consist of arterial balloon occlusion and arterial embolization. The operator is supposed to be decisive regarding the choice of interventional technique, and embolic material depending on the patient’s vital signs and cause/site of bleeding. Understanding of the intra-pelvic collateral pathway is essential for obstetrical and gynecologic arterial embolization because of the possibility of bleeding via rich collateral vessels. Postpartum hemorrhage (PPH) is one of the most critical causes of obstetric emergency. Recently, endovascular treatment has been focused on as an effective and safe technique to save PPH patients. Atonic bleeding is the most common cause of primary PPH. Secondary PPH is due to various causes and is less frequent and less critical compared to primary PPH. The main embolic materials chosen for PPH are gelatin sponge and NBCA. Gelatin sponge is commonly chosen first. NBCA can be appropriate for traumatic bleeding, pseudoaneurysm, recanalization after gelatin sponge embolization, and acquired AVM/AVF. Of gynecologic emergencies, tumor bleeding is the predominant indication for endovascular treatment. Various feeding arteries including the mesenteric artery can be the origin of bleeding because of tumor invasion. IPM/CS may be considered for bleeding from the mesenteric artery.
