Emergent Uterine Artery Embolization for Postpartum Hemorrhage

Omar Chohan, DO

Vascular Interventional Radiologist

Gates Vascular Institute

A 33-year-old female underwent low transverse cesarean section and was found to have a posterior uterine wall rupture which was repaired.
After surgery, a CT scan revealed concern for a uterine artery bleed, and she underwent bilateral uterine artery embolization with Gelfoam. However, after 24 hours she continued to bleed.
She returned to the OR for supracervical hysterectomy and ligation of left uterine artery. However, she continued to pass fresh blood, so patient was brought for emergent bilateral uterine artery embolization.
Arteriography revealed a uterine artery rupture with large volume extravasation into the pelvis.
A LOBO-3 was deployed through a 2.8F PROGREAT microcatheter and provided rapid occlusion with a single device without the need for additional coils or occlusion devices.
LOBO-3 was able to be deployed accurately with a predictable landing zone and no migration. Given time was important, rapid occlusion was desired.
Patient had a good clinical response following embolization with LOBO-3.

Figure 1: Selective catheterization and angiography of the left uterine artery showing active bleed.

Figure 2: Still shot of LOBO-3 (bracket) within the left uterine artery just before deployment.

Figure 3: Post embolization arteriography showing LOBO-3 (bracket) in distal left uterine artery successfully occluding the vessel with no further extravasion.

LOBO is ideal in emergent bleeding cases where rapid predictable occlusion performance matters. Accurate deployment ensures that the target vessel is treated without non-target embolization.