Massive postpartum hemorrhage is a medical emergency that requires rapid response to prevent the patient's exsanguination. A common intervention is vascular intervention to reduce the uterine blood supply. Unfortunately, this can sometimes interrupt the blood supply too much, resulting in uterine ischemia and necrosis.
Patient selection: woman with massive postpartum hemorrhage
Vascular interventions may include:
(1) intra-arterial embolization
(2) interruption of uterine arteries, which can be done with compression sutures
(3) ligation of the hypogastric artery (internal iliac artery)
(4) uterine branch of the ovarian artery
Complications:
(1) reversible ischemia
(2) uterine ischemic necrosis
(3) uterine involution
(4) uterine infertility
(5) infection with sepsis
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