External iliac artery-related postpartum hemorrhage: report of one case with literature review

Objective: To explore the imaging features of external iliac artery-related postpartum hemorrhage, and to discuss its interventional therapy measures. Methods: The clinical data and imaging findings of one patient with external iliac artery-related postpartum hemorrhage was retrospectively analyzed. The patient received interventional therapy at the intervention department of Shanxi provincial people's hospital. The relevant academic papers published in medical literature were reviewed. The common features of this condition were summarized, and the imaging features and the interventional therapy measures were discussed. Results: A total of 4 patients, including authors' case, with external iliac artery-related postpartum hemorrhage were reported in China. Of the 4 case, right external iliac artery-related postpartum hemorrhage was seen in 2 and bilateral external iliac artery-related postpartum hemorrhage was seen in other two. Embolization therapy of three abnormal branches of deep circumflex iliac artery that participated in the uterine blood supply was carried out. Immediately after the embolization the bleeding stopped. Conclusion: For the treatment of postpartum hemorrhage, uterine arterial embolization should be followed by abdominal aorta angiography so as to check the external iliac artery. When recurrent bleeding occurs after uterine arterial embolization, the possibility that the abnormal branches of external iliac artery participates in the uterine blood supply should be considered. In performing the embolization of abnormal branches of external iliac artery, the catheter should be inserted to the distal end of the target vessel. Under DSA monitoring the embolic agent should be slowly injected into the targeted artery and the patient should be kept under close observation for blood reflux. Usually, the embolization of abnormal branches of external iliac artery will not cause ischemic symptoms of the pelvis and distal limbs. (authors)