Novel treatment approach for recurrent secondary postpartum hemorrhage

Abstract

Postpartum hemorrhage (PPH) remains a major cause of both maternal mortality and morbidity worldwide. PPH is a nightmare for obstetricians. Uterine artery embolization (UAE) has a high success rate in controlling bleeding from secondary PPH, with a success rate of 85%. UAE is particularly useful for PPH caused by uterine atony, retained placental fragments, or abnormal blood vessel formation (AVM). We report a case of a recurrent secondary PPH which was successfully treated with uterine arterial embolization. A 36‐year‐old female, Para‐3, with a history of two previous cesarean sections, presented with massive per vaginal bleeding 40 days after cesarean section due to twin pregnancy. On the 17th post‐operative day of cesarean section, she developed severe secondary PPH and underwent D & C for retained product of conception. After the procedure, bleeding continued on and off but the last episode was catastrophic. After initial resuscitation and hemodynamic stabilization and medical management, her bleeding was reduced but still persisted. She received 11 units of blood transfusion throughout the postpartum period .Her ultrasound was done which suspected C‐section site‐acquired arteriovenous malformation. Considering her age and desire to preserve fertility, the patient underwent bilateral uterine arteriovenous embolization by coils. Her per vaginal bleeding dramatically reduced after the procedure. UAE is often considered when conservative management fails to control bleeding or surgical interventions are not preferred. UAE is a fertility‐sparing option, allowing women to potentially have future pregnancies. Compared to surgical interventions like hysterectomy, UAE is less invasive, resulting in short hospital stay and faster recovery times. In essence, UAE is an available tool in the multidisciplinary approach to managing secondary PPH in a tertiary care center.