Postpartum hemorrhage (PPH) / bleeding after giving birth (delivery)

Postpartum hemorrhage is defined as heavy intrauterine bleeding after the birth. Sudden loss of blood could result in a severe drop in the blood pressure and possibly lead in shock, even death if not treated. The most common underlying etiology of postpartum hemorrhage is uncontracted uterus after delivery. Postpartum hemorrhage is the leading cause of postpartum mortality. Women of child bearing age who carry a pregnancy beyond 20 weeks’ gestation are at the higher risk for postpartum hemorrhage.

In this animation, we show how postpartum hemorrhage is managed by image guided procedure through a radial access. This procedure is commonly done by interventional radiology service.

00:22 As a first step, the left radial artery is accessed under ultrasound guidance using a micropuncture needle. Once the blood return is noted, a wire is advanced through the needle into the left radial artery.

00:40 The needle is subsequently exchanged for a slim sheath.

00:45 Once the slim sheath is properly placed, the wire and inner dilator are removed.

00:50 A mixture of vasodilators is injected through the sheath to avoid arterial spasm. Then, normal saline is continuously infused through the sheath to avoid possible clotting.

01:07 A combination of catheter and wire is advanced from the radial artery to the aorta and subsequently to the internal iliac artery.

01:24 The wire is exchanged for a combination of microcatheter and microwire, which are advanced to the uterine artery.

01:34 Once the bleeding area is identified, the bleeding artery is occluded with coil or embolized with temporary embolics/particles, which stops bleeding.

01:44 All catheters and microcatheters are removed. Then, saline infusion is stopped.

01:53 The wrist is lifted. Then, a TR band is placed on the wrist, inflated with air, and the sheath is removed. Finally, the amount of air within the TR band is adjusted.