Pelvic arterial embolisation in obstetrics and gynaecology

Arterial embolisation has been used for > 20 years to control acute haemorrhage secondary to obstetric and gynaecologic disease. The use of this technique to specifically address pelvic haemorrhage in three major categories has increased in recent years. Embolisation is used to control acute pelvic haemorrhage in post-partum bleeding, postoperative bleeding and trauma, with success rates > 95%. Early consultation with the interventional radiologist and modern angiographic equipment are key factors in achieving successful embolotherapy. Uterine artery embolisation (UAE) is increasingly used to treat symptomatic uterine fibroids in women who wish to retain their uterus. Careful pre-procedural evaluation is paramount. Complications are uncommon and 85-90% of women report significant improvement of symptoms. Complex pelvic masses, such as ectopic pregnancies, arteriovenous malformations (AVM) and cancer-related haemorrhage are also amenable to embolotherapy. Post-embolisation symptom recurrence is frequent in AVM and malignancy cases, due to the rapid recruitment of collaterals. In all cases, good communication between the obstetrician/gynaecologist and the interventional radiologist is a key factor in ensuring the success of embolotherapy procedures in obstetrics and gynaecology patients.