UAE: A Game-Changer in Obstetric Hemorrhage?

Uterine Artery Embolization (UAE) is a minimally invasive procedure used to control obstetric hemorrhage, particularly in high-risk cases. It involves an interventional radiologist inserting a catheter through the femoral artery to the uterine arteries. Small particles are then released to block the blood flow to the uterus, thereby stopping the bleeding. This technique is especially beneficial when traditional methods like uterotonic agents fail or when surgical interventions pose high risks. UAE helps preserve fertility by avoiding more invasive procedures like hysterectomy, and it minimizes surgical blood loss and morbidity, leading to improved maternal outcomes.

UAE is often considered in high-risk obstetric scenarios where there is a significant risk of postpartum hemorrhage (PPH). This includes cases involving morbidly adherent placenta, previous surgeries, dense adhesions, or complete placenta previa, where traditional surgical approaches might be exceptionally risky. For example, in the presented case, the patient had a history of prior surgeries and adhesions, making a repeat caesarean section high-risk. In such situations, UAE offers a less invasive alternative to hysterectomy, with a focus on preserving fertility.

Traditional first-line treatments for obstetric hemorrhage typically involve uterotonic agents to contract the uterus and reduce bleeding. When these are insufficient, surgical interventions, ranging from selective artery embolization to hysterectomy, may be necessary. UAE distinguishes itself by being a less invasive option than surgery, especially in complex cases. It offers the advantage of preserving fertility while effectively controlling bleeding. Unlike hysterectomy, which permanently ends fertility, UAE allows for the possibility of future pregnancies, making it a preferred choice for patients who wish to have more children and when surgical options are limited.

In the described case, a 38-year-old patient underwent a pre-operative uterine artery catheterization. Bilateral uterine artery balloon catheters were placed via a transcutaneous femoral approach under local anesthesia by an interventional radiologist. During the caesarean section, the bladder was found adhered to the lower uterine segment. After the delivery, the uterine artery balloons were inflated, significantly reducing bleeding. Subsequently, fluoroscopy revealed hyper vascularity near the anterior division of the left-sided internal iliac artery, prompting selective embolization of the affected artery. The challenges included dense adhesions from prior surgeries and a bladder injury, which was carefully managed during the procedure.

The primary benefits of UAE in obstetric emergencies include reduced surgical blood loss, lower morbidity rates, and the preservation of fertility. In the described case, the patient experienced minimal blood loss, and her post-operative recovery was uneventful. By avoiding more invasive surgical interventions such as hysterectomy, UAE enables patients to maintain their fertility. It can significantly improve maternal outcomes, allowing for a quicker recovery and a better quality of life. Moreover, in the hands of a skilled interventional radiologist, UAE can be a safer and more effective approach compared to traditional surgical methods, especially in high-risk situations.