Postpartum haemorrhage (2025 – CME) – online course

Description

Authors: S. Protto and L. Ratnam

Reviewers: T. Bilhim, G. Eldem, J. Guirola, P. Lohle, H. Moriarty, C. Nice and F. Wolf

This course corresponds to chapter 2.2.1.1.9 Arterial problems in obstetrics and gynaecology in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

Postpartum haemorrhage (PPH) occurs in 6% of all deliveries, is responsible for 25% of maternal deaths worldwide, and is the leading cause of acute hysterectomy [1]. PPH is defined by the World Health Organization (WHO) as blood loss of >500 ml either in vaginal or caesarean delivery [1], [2]. The most common causes of PPH include uterine atony (80%), laceration of the genital tract, retention of placental fragments, coagulopathy, and abnormal placentation. The incidence of abnormal placentation is increasing in frequency, most likely due to the higher rate of caesarean section rate, with a quoted mortality rate ranging from 7-10% worldwide [3], [4], [5]. The most common form is placenta accreta (75-78%), followed by placenta increta (17%), and placenta percreta (5%). The diagnosis of abnormal placentation of all three types is usually made with ultrasound identification.

In cases of PPH, interventional radiologists should be part of the multidisciplinary team treating the patient. If conservative management steps are not successful, endovascular treatment should be attempted. In the majority of these cases, transarterial embolization (TAE) by means of non-permanent embolic material is successful. In cases of abnormal placentation diagnosed in the antenatal period, the placement of prophylactic occlusion balloons in the internal iliac arteries or even in the infrarenal aorta is increasingly used to manage these complex patients, with embolization performed if required.

The results of these techniques are extremely good, with reported haemorrhage control of up to 100% [6], [7], [8]. In general, failure of treatment is due to the presence of collateral vessels or vasoconstriction during the procedure. In these cases, however, a second attempt to embolize often treats the bleeding. Moreover, no adverse effects on fertility have been reported.

TAE and prophylactic placement of occlusion balloons are safe and effective treatments in patients presenting respectively with PPH and abnormal placentation.

Learning objectives

• Describe the vascular anatomy of the female pelvis
• Explain the difference between primary and secondary PPH, list the causes of PPH, and the possible different treatments (i.e., in uterine atony vs abnormal placentation)
• Recognize the indications for uterine artery embolization in PPH and abnormal placentation
• Recognize the appropriate embolic agent to utilize in PPH and the reason for use. Describe the principles of performing uterine artery embolization for PPH and placement of prophylactic occlusion balloons
• Summarize the potential complications of TAE and occlusion balloons, as well as the management of these complications

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.1.9 Arterial problems in obstetrics and gynaecology.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one and a half hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1.5 European CME credits (ECMEC). The CME accreditation for this course will expire on March 18, 2027. A non-CME accredited version of the course will remain available until March 19, 2029.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: March 2025