Embolización de las arterias uterinas en el manejo de la hemorragia obstétrica

Abstract

Introduction: Primary postpartum hemorrhage (PPH) is commonly defined as genital tract bleeding equal to or greater than 500 ml within 24 hours of delivery. It is one of the most common causes of maternal mortality worldwide and a leading cause of physical and psychological morbidity. In patients with uncontrolled bleeding who do not respond to medical treatment, various surgical procedures are used, such as devascularization surgeries and hysterectomy, uterine tamponade, insertion of an intrauterine balloon, arterial ligation/embolism, or uterine compression. Objective: To describe the efficacy of uterine artery embolization (UAE) in managing obstetric hemorrhage according to the scientific literature. Methodology: A narrative literature review was carried out in studies, meta-analyses, systematic reviews, controlled clinical trials, cohort studies, and bibliographic reviews reporting information on managing postpartum hemorrhage by uterine artery embolization from 2018 to 2023 in English and Spanish. Results: Thirty-two articles were selected, in which the UAE was found to be a safe and minimally invasive treatment for postpartum hemorrhage with a success rate higher than 90%. The main indications for UAE are hematomas, coagulopathies, hereditary bleeding disorders such as von Willebrand's disease, and treatment of bleeding related to ectopic pregnancy. Conclusions: UAE is an effective treatment modality for obstetric hemorrhage in patients with PPH, with a high technical and clinical success rate and no significant major complications.