Since the initial description of selective
uterine artery embolization for the treatment of
postpartum hemorrhage in 1979, transcatheter embolization and other
endovascular techniques have become the second-line therapeutic option for the management of intractable obstetrical and gynecologic
bleeding. Advances in
catheter-based techniques, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of
hemorrhage for a variety of indications, such as
postpartum hemorrhage,
menorrhagia, and postmenopausal
bleeding. Transcatheter interventions include the following: (1) prophylactic selective catheterization of the internal iliac arteries, with either temporary balloon occlusion or
embolotherapy; (2) selective embolization of collateral pelvic vessels in the setting of surgical
ligation of the internal iliac arteries and/or delivery-related
injuries to the genital tract; (3) transarterial embolization for the management of abnormal placentation; and (4) massive
bleeding secondary to uterine
leiomyomas (
fibroids) and/or
arteriovenous malformations. Transcatheter embolization is a fast, safe, and effective minimally invasive alternative to
hysterectomy, when medical treatment fails to control
uterine bleeding. Moreover, it preserves the uterus with little or no significant impact on future pregnancies and fertility. This article reviews the transcatheter
endovascular techniques that are used in a variety of clinical scenarios for the management of obstetrical and gynecologic emergencies.