Complications of embolization are relatively uncommon but can be severe. Case reports detail instances of iatrogenic iliac artery rupture, uterine ischemic necrosis, and uterine infection (Gronvall, 2014; Katakam, 2009; Nakash, 2012). Finally, l-hunyan and coworkers (2012) described a woman with massive buttock necrosis and paraplegia following bilateral internal iliac artery embolization.
In a few instances, massive blood loss and diicult surgical dissection is anticipated. The use of balloon-tipped catheters preoperatively inserted into the iliac or uterine arteries was described earlier in management of placenta accrete syndromes (p. 781).
For significant bleeding refractory to suture or topical hemostats, pelvic packing with gauze and termination of the operation may be considered. Rolls of gauze are packed to provide constant local pressure. This may serve as a temporizing step prior to interventional embolization. In other cases, packing alone may be left for 24 to 48 hours. If the patient is stable and bleeding appears to have stopped, packing is removed.
The umbrela orparachute pack uses a similar concept (Logothetopulos, 1926). Although seldom used today, it can be lifesaving if all other measures have failed, especially in low-resource areas (Dildy, 2006; Howard, 2002). The pack is constructed of a sturdy sterile plastic bag that is illed with gauze rolls that are unwound and knotted together. Suicient rolls are used to provide enough volume to fill the pelvis. he pack is introduced transabdominally with the stalk exiting the vagina. Mild traction is applied by tying the stalk to a I-liter fluid bag, which is hung over the foot of the bed. The umbrella pack is removed vaginally after 24 hours.
Abbassi-Ghanavati M, Casey BM, Spong CY, et al: Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet Gynecol 116:381, 2010 Abdel-Aleem H, El-Nashar I, Abdel-Aleem A: Management of severe post partum hemorrhage with misoprostol. Int] Gynaecol Obstet 2:75, 2001 Abdella TN, Sibai BM, Haysn]M ]r, et al: Perinatal outcome in abruptio placentae. Obstet Gynecol 63:365, 1984
Abdul-Kadir R, McLintock C, Ducloy AS, et al: Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 54(7): 1756, 2014
Abramovici A, Gandley E, Clifton RG, et al: Prenatal Vitamin C and E supplementation in smokers is associated with reduced placental abruption and preterm birth: a secondary analysis. B]OG 122(13):1740,n2015
Adamsons K, Mueller-Heubach E, Myers RE: he innocuousness of amniotic fluid infusion in the pregnant rhesus monkey. Am ] Obstet Gynecol 109:977, 1971
Addis A, Moretti ME, Ahmed Syed F, et al: Fetal efects of cocaine: an updated meta-analysis. Reprod Toxicol 15:341, 2001
Ahmed S, Harrity C, Johnson S, et al: The eicacy of ibrinogen concentrate compared with cryoprecipitate in major obstetric haemorrhage-an observational study. Transfus Med 22(5):344,n2012