Article ID: HRP2015-016
Initial treatment is crucial for saving the lives of patients with primary postpartum hemorrhage (PPH). Interventional radiology (IR) has become a major focus as a potential treatment for primary PPH because of its prompt hemostasis, low invasiveness, and the possibility of preserving fertility. Establishing and disseminating a management algorithm that allows for smooth communication between medical staff involved in the treatment is essential for prompt IR. IR for primary PPH consists of transcatheter arterial embolization (TAE) and balloon occlusion. Emergency introduction of infrarenal intraaortic balloon occlusion (IABO) can be useful for achieving temporary hemostasis in patients in critical condition. TAE has a high chance of successful hemostasis in cases of atonic bleeding. IR can also be introduced for other bleeding etiologies, but the order of priority — with respect to surgery and IR — has to be evaluated appropriately according to bleeding etiology, hemodynamic stability, human resources, and accessibility to operating and angiographic rooms. Patient transportation must also be considered for intensive and invasive treatment if conservative treatment is not successful. IR is the preferred first-line hemostatic measure, especially for atonic bleeding, with advantages such as low invasiveness, fewer complications, and preservation of fertility.
