EMBOLIZATION OF THE UTERINE ARTERIES FOR LATE POSTPARTUM HEMORRHAGE DUE TO METROENDOMETRITIS: A CLINICAL CASE

Abstract

Bleeding between 24 hours and 42 days after delivery is called "late postpartum bleeding" or "secondary postpartum bleeding, which is a serious obstetric complication due to the danger to the life and health of a woman. The main causes of bleeding in the late postpartum period are the retention of parts of the placenta in the uterine cavity and the hematometer. Both conditions lead to a violation of the contractility of the uterus with the development of its subinvolution, an inflammatory reaction of the endometrium and, as a result, uterine bleeding against the background of the progressive clinical picture of postpartum endometritis. The lack of a single algorithm for the treatment of late postpartum bleeding can lead to a variety of approaches and treatment results from different doctors. Uterine artery embolization (UAE) can successfully control severe uterine bleeding, it should be considered as one of the primary means to reduce the risk of unwanted hysterectomy, blood transfusions, and the risk of disability in the postpartum period. The world literature describes a case of uterine artery embolization in secondary postpartum bleeding on the background of placental tissue residues and metroendometritis. The overall efficiency index for UAE ranges from 86% to 96%. In 2024, in the Department of Gynecology of the Multidisciplinary City Hospital No. 1 in Astana, TAE was successfully performed in cases of late postpartum bleeding, which demonstrated the high effectiveness and safety of this treatment method