Management of primary postpartum haemorrhage with arterial embolisation in Hong Kong public hospitals.

Objective: To assess the utilisation, effectiveness, and safety of arterial (angiographic) embolisation for management of severe primary postpartum haemorrhage in Hong Kong public hospitals. DESIGN. Retrospective study.

Methods: All eight obstetrics and gynaecology units of the Hospital Authority in Hong Kong. Methods: Women who underwent arterial embolisation for primary postpartum haemorrhage from July 1999 to June 2004 inclusive. Methods: Cause of primary postpartum haemorrhage, estimated blood loss, patient condition before embolisation, and the intervals between the diagnosis of postpartum haemorrhage and the procedure.

Results: Primary postpartum haemorrhage occurred in 7200 (3.9%) cases of 183,700 deliveries; 90 (0.05%) underwent total hysterectomy, whilst 29 (0.016%) received angiographic embolisation. Arterial embolisation was 90% effective in treating medically uncontrollable primary postpartum haemorrhage, except in three patients who failed to respond and underwent a hysterectomy. All 29 patients survived, although due to severe haemorrhage one had a cardiac arrest, whilst another had transient right-leg claudication. Six patients developed mild fever.

Conclusions: In Hong Kong, arterial embolisation for severe primary postpartum haemorrhage is a safe and effective treatment modality but is underutilised. If first-line medical treatment fails and patients are haemodynamically stable, the procedure should be considered an alternative management option. A prompt decision and early resort to arterial embolisation are advisable so as to reduce the morbidity and avoid resorting to open surgery.