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Abstract: Uterine necrosis is one of the rarest complications following pelvic arterial embolization for postpartum hemorrhage (PPH). With the increasing incidence of cesarean section and abnormal placental localization (placenta previa) or placental invasion (placenta accreta/increta/percreta), more and more cases of uterine necrosis after embolization are being diagnosed and reported. Pelvic computed tomography or magnetic resonance imaging provides high diagnostic accuracy, and surgical management includes hysterectomy. We performed a Medline database query following the first description of uterine necrosis after pelvic embolization (between January 1985 and January 2013). Medical subheading search words were the following: “uterine necrosis”; “embolization”; “postpartum hemorrhage”. Seventeen citations reporting at least one case of uterine necrosis after pelvic embolization for PPH were included, with a total of 19 cases. This literature review discusses the etiopathogenesis, clinical and therapeutic aspects of uterine necrosis following pelvic arterial embolization, and guidelines are detailed. The mean time interval between pelvic embolization and diagnosis of uterine necrosis was 21 days (range 9–730). The main symptoms of uterine necrosis were fever, abdominal pain, menorrhagia and leukorrhea. Surgical management included total hysterectomy (n =15, 78%) or subtotal hysterectomy (n =2, 10%) and partial cystectomy with excision of the necrotic portion in three cases of associated bladder necrosis (15%). Uterine necrosis was partial in four cases (21%). Regarding the pathophysiology, four factors may be involved in uterine necrosis: the size and nature of the embolizing agent, the presence of the anastomotic vascular system and the embolization technique itself with the use of free flow embolization. [Copyright &y& Elsevier]

To evaluate the rate of success and practicability of the intrauterine tamponade balloon (ITB) for managing PPH as a fertility-sparing tool. Methods: a five-year retrospective monocentric study in a tertiary care center including patients transferred for severe PPH. Results: In 231 patients, the success rate of ITB (n = 57), embolization (n = 58), and medical management (n = 114) was 84.21%, 74.13%, and 76.32%, respectively. Cesarean section during labor did not influence the risk of advanced interventional procedures (AIPs) for patients with ITB (odds ratio [OR] = 1.08) but did so in patients who were under expectant management in the intensive care (OR = 5.29). In the AIP subgroup of the ITB group, hemostasis was significantly deteriorated. Prothrombin time <50% (OR = 11.5), fibrinogen <2 g/L (OR = 6.88), and >4 red blood cells units (RBCs) transfused (OR = 17.2) were associated with a significantly higher risk of failure. Blood loss in the AIP patients in the embolization group was significantly higher. Patients requiring >4 units of RBCs were 22.9 times more likely to have an AIP (p =.0001). Conclusion: Compared with uterine embolization and medical management, ITB use in a tertiary care center was associated with lower risk of undergoing AIP, but further prospective study is required to confirm this. [ABSTRACT FROM AUTHOR]