Emergency Uterine Artery Embolization for Postpartum Hemorrhage: Hemostatic Outcomes According to Embolic Material and Shock Index, with Subsequent Pregnancy Outcomes.

PURPOSE: To compare hemostatic efficacy and subsequent pregnancy outcomes of gelatin sponge (GS) and n-butyl-2-cyanoacrylate (NBCA) in emergency uterine artery embolization (UAE) for postpartum hemorrhage (PPH), with Shock Index (SI) as an indicator of bleeding severity.

MATERIALS AND

METHODS

We retrospectively reviewed 51 patients who underwent emergency UAE for uncontrolled PPH between January 2012 and December 2024. Hemostatic outcomes were evaluated in all patients. Forty-eight patients with SI data were stratified into three groups: SI <1.0 (n=19), 1.0≤SI<1.5 (n=18), and SI≥1.5 (n=11). Pregnancy outcomes were assessed in 46 patients with uterine preservation and available SI data.

RESULTS

Initial embolization used GS in 44 patients (86.3%) and NBCA in 7 (13.7%). The DIC score was higher in the initial NBCA group than in the initial GS group (median, 9 vs. 7; p = 0.017). Initial embolization succeeded in 41 patients (80.4%), including 34/44 (77.3%) with GS and 7/7 (100%) with NBCA (p=0.320). Of 10 initial GS failures, 8 were converted to NBCA and 2 underwent hysterectomy. Final hemostatic success was achieved in 49 patients (96.1%), including all 8 converted cases. Among 46 patients with uterine preservation and available SI data, 9 achieved pregnancy: 6/31 (19.4%) after GS alone and 3/15 (20.0%) after NBCA, including GS-to-NBCA conversion (p=1.000).

CONCLUSION

NBCA was effective for hemostasis in emergency UAE for PPH, including after conversion from GS. Subsequent pregnancy rates were comparable between GS alone and NBCA through April 30, 2026.