Author ’ s Accepted Manuscript Postpartum Hemorrhage ( PPH )

Interventional radiologists are often called for emergent control of abnormal uterine bleeding. Bleeding, even heavy bleeding as a result of uterine fibroids is not a common emergent procedure; instead, pregnancy and pregnancy related conditions, trauma and malignancy associated with bleeding can be the source of many interventional radiology on call events/procedures. Postpartum hemorrhage (PPH) is the most common cause, and is defined as blood loss of 500 mL after vaginal delivery or 1000 mL after cesarean section[1]. Several authors have suggested a simpler definition of any amount of blood loss that creates hemodynamic instability in the mother[2]. Regardless, PPH can be a life-threatening emergency and is a leading cause of maternal mortality requiring prompt action. Primary PPH is bleeding within the first 24hrs of delivery and secondary PPH is hemorrhage that occurs more than 24hrs after delivery. In addition to death, other serious morbidity resulting from post-partum bleeding includes shock, adult respiratory distress syndrome, coagulopathy and loss of fertility due to hysterectomy. Transcatheter uterine artery embolization was first introduced as a treatment for PPH in 1979[3]. It is a nonsurgical, minimally invasive, extremely safe and effective treatment for controlling excessive bleeding of the female reproductive track usually after conservative measures have failed, yet somewhat underutilized[4]. Referring providers have limited awareness of the procedure. In hospitals where interventional radiologists have the experience and technical expertise to perform pelvic arteriography and embolization, this therapeutic option can play a pivotal role in the management of emergent obstetric hemorrhage.