An emergency embolization that stops severe bleeding after childbirth — recommended by international guidelines before hysterectomy, to preserve the uterus.
Postpartum hemorrhage is heavy bleeding following childbirth, generally defined as blood loss of 500 mL or more after a vaginal delivery, or 1000 mL or more after a caesarean section, or bleeding accompanied by signs of significant blood loss such as a falling blood pressure or rising heart rate. It affects a meaningful proportion of deliveries and remains, globally, one of the leading causes of maternal death — which is why rapid recognition and a clear, well-rehearsed escalation pathway matters enormously in every delivery unit.
Most cases of PPH are managed successfully with first-line measures: uterine massage, medications that help the uterus contract (uterotonics), and, where the cause is a tear or laceration, surgical repair. When bleeding continues despite these measures — refractory PPH — the situation becomes more urgent, and this is precisely the point at which uterine artery embolization becomes relevant.
Continuing despite uterine massage, uterotonics, and repair of tears.
The woman is stable enough to safely undergo the procedure.
A specialised interventional radiology team can respond in a timely manner.
A needle puncture is made in one or both femoral arteries.
Contrast dye identifies the source of active bleeding.
Embolic material blocks the bleeding vessels on both sides.
A final angiogram confirms bleeding has stopped.
The most common cause by far is uterine atony — the uterus failing to contract firmly enough after delivery to close off the blood vessels at the placental site, which normally happens naturally. Other causes include retained placental tissue, tears or lacerations of the birth canal, and abnormal placentation, where the placenta has grown too deeply or in an abnormal position within the uterine wall (placenta accreta and related conditions), which can cause severe bleeding at delivery. Identifying the likely cause helps guide both immediate management and, where embolization is needed, exactly which vessels need to be treated.
International obstetric guidelines — including from major bodies such as ACOG and FIGO — recommend considering uterine artery embolization before proceeding to hysterectomy in a woman with PPH who remains haemodynamically stable and where a specialised interventional radiology team is available in a timely manner. The reasoning is straightforward: embolization can be highly effective at stopping the bleeding while preserving the uterus, avoiding a major, often technically difficult emergency operation and its long recovery, and — critically for many women — preserving the possibility of future pregnancies.
This doesn't mean embolization is always the right first step; a woman who is haemodynamically unstable, or in whom an interventional radiology team and angiography suite aren't rapidly available, may need to proceed directly to surgical management, including hysterectomy if that becomes necessary to save her life. The decision is made rapidly, by the obstetric team managing the emergency, based on how the patient is responding and what resources can be mobilised quickly enough to help her safely.
Access: under local anaesthesia, a needle puncture is made in one or both femoral arteries in the groin.
Angiography: a catheter is guided to the internal iliac arteries and then selectively into the uterine arteries on each side, with contrast dye used to identify active bleeding (contrast extravasation) or other abnormal findings, such as a pseudoaneurysm.
Embolization: an embolic material — commonly a temporary, absorbable agent, though the choice depends on the clinical situation — is injected to block the bleeding vessels on both sides.
Additional vessels: in some cases, the ovarian arteries also need to be embolized if they're found to be contributing significant blood flow to the bleeding, since the uterus and ovaries share overlapping blood supply routes.
Confirmation: a final angiogram confirms bleeding has stopped, and the patient returns to obstetric care for close monitoring.
Because this is an emergency procedure performed on a recently delivered, sometimes critically unwell patient, it's carried out in close, real-time coordination with the obstetric and anaesthetic teams throughout, often with the patient still being actively resuscitated alongside the procedure itself.
Published outcomes across many case series consistently show uterine artery embolization successfully controls bleeding in the large majority of cases — commonly cited figures fall in the range of 85% to over 90% — avoiding hysterectomy for most women treated. Where embolization doesn't fully control the bleeding, options include re-embolization or, if necessary, proceeding to hysterectomy, which remains a life-saving option of last resort when other measures haven't worked. Because fertility preservation matters so much in this group of typically young women, published long-term follow-up has generally been reassuring regarding subsequent pregnancies, though some studies note a somewhat higher rate of recurrent PPH in a subsequent pregnancy compared with women who didn't have a prior PPH — useful information for planning and closely monitoring any future delivery, without suggesting future pregnancy itself should be discouraged.
Unlike most procedures on this site, uterine artery embolization for PPH is almost never planned in advance — it happens in the middle of an obstetric emergency, often within the same hospital stay as delivery, sometimes within hours of it. Good outcomes depend on a delivery unit having a clear, well-rehearsed pathway for escalating refractory bleeding, immediate access to an interventional radiology team and angiography suite, and close, continuous communication between obstetrics, anaesthesia, and interventional radiology throughout. This is why availability of an experienced interventional radiology service, around the clock, is such an important part of comprehensive maternity care at a hospital equipped to manage high-risk deliveries.
When bleeding continues despite first-line measures — uterine massage, medications to help the uterus contract, and repair of any tears — embolization is the recommended next step by major obstetric guidelines, in a stable patient where an interventional radiology team is available promptly.
In the large majority of cases, yes — published success rates are generally in the 85% to over 90% range for controlling bleeding, meaning most women avoid hysterectomy. In a minority of cases where embolization doesn't fully control the bleeding, hysterectomy may still become necessary as a life-saving measure.
Embolization is specifically valued because it preserves the uterus, and published follow-up studies have generally been reassuring about subsequent pregnancies, though some data suggest a somewhat higher chance of PPH recurring in a future delivery, which is something your obstetric team will plan and monitor for.
No — it's an emergency treatment used when significant bleeding occurs after delivery and doesn't respond to first-line measures. It isn't something arranged ahead of time, though hospitals with high-risk pregnancies sometimes have interventional radiology on standby for anticipated higher-risk deliveries, such as known placenta accreta.
If bleeding is very severe and the patient is haemodynamically unstable, or if an interventional radiology team isn't rapidly available, the obstetric team may need to proceed directly to surgical management, including hysterectomy if necessary, to protect the patient's life.
This is a medical emergency — call immediately, or your obstetric team can reach Dr. Giragani's interventional radiology service urgently.