Arterial embolization has been successfully used as a safe and effective uterus-preserving treatment strategy in postpartum hemorrhage (PPH) that is refractory to conservative management. Endometritis is a common complication of arterial embolization for PPH, among others such as iliac artery perforation, groin haematoma, transient buttock ischemia, transient foot ischemia and bladder gangrene.¹ Undiagnosed and untreated endometritis may lead to formation of abscesses often necessitating a hysterectomy.

A new single-center study published in the Journal of Obstetrics and Gynaecology attempted to identify the risk factors for endometritis following arterial embolization for PPH.² For this, they enrolled 20 patients who underwent arterial embolization for PPH at a hospital in Japan from 2005 to 2020. Eight of the 20 patients (40%) developed endometritis, while 12 patients did not.

Women who had a minimum of two out of the following criteria ≥3 days after the procedure were diagnosed as having endometritis: Body temperature ≥38 °C, tenderness in lower abdomen/abdomen and purulent cervical discharge.

Various factors such as age, body mass index, parity, gestational week, infant birth weight, caesarean section operative time, labor duration for vaginal deliveries, blood transfusion, length of hospital stay and time to arterial embolization from delivery were examined. Except for extravasation of contrast medium, duration of hospitalization and blood volume, all remaining factors were comparable between the two groups.

The rate of extravasation of the contrast medium on CT scans before the procedure was higher in 75% women who developed endometritis compared to 16.7% women. The median duration of hospitalization was 25 days in the endometritis group vs 11 days in the non-endometritis group. A significant difference was noted for bleeding volume >2500 mL between the two groups with relative risk 4.5 compared to those who did not develop endometritis.

This study establishes extravasation of contrast medium and the blood loss greater than 2500 mL as strongly predictive of endometritis among women who underwent arterial embolization for PPH. Identification of these factors facilitates early detection of high risk women and enables timely diagnosis followed by aggressive treatment.

References

1. Wee L, et al. Management of severe postpartum haemorrhage by uterine artery embolization. Br J Anaesth. 2004 Oct;93(4):591-4. doi: 10.1093/bja/aeh237.
2. Yoshida T, et al. Endometritis risk factors after arterial embolisation for postpartum haemorrhage. J Obstet Gynaecol. 2023 Jan. 6;43(1):2158323. doi: 10.1080/01443615.2022.2158323.