Postpartum Haemorrhage

Postpartum bleeding or postpartum haemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth.

A) Emergency intervention:

Interventional radiology should be considered in the management of postpartum haemorrhage secondary to:

Atonic uterus following normal or prolonged labour

Surgical complications or uterine tears at the time of caesarean section

Bleeding while on the recovery unit or in the postnatal ward following a normal delivery or a caesarean section

Bleeding following hysterectomy

In order for interventional radiology to be performed in the emergency situation, access to imaging is desirable either in the obstetric unit or in an adjacent special procedures unit in the radiology department

In all these situations, access to the bleeding arteries and subsequent embolization with a suitable embolic material (such as absorbable gelatine preparations) under image guidance should be considered.

B) Elective and prophylactic intervention:

Interventional radiology can also be used as a prophylactic measure where there is a known or suspected case of placenta accrete, such as placenta praevia on previous caesarean section scar, or placenta accreta diagnosed by scan/colour Doppler or magnetic resonance imaging. Balloons are placed in the internal iliac or uterine arteries before delivery. The balloons can be inflated to occlude the vessels in the event of postpartum haemorrhage. Embolization can be performed via the balloon catheters if bleeding continues despite inflation.