Efficacy of Selective Arterial Embolisation for the Treatment of Life-Threatening Post-Partum Haemorrhage in a Large Population Cyril Touboul1., Wassim Badiou1., Julien Saada1, Jean-Pierre Pelage2, Didier Payen3, Eric Vicaut4, Denis Jacob 1 , Arash Rafii5* 1 Department of Obstetrics and Gynaecology, H oˆpital Lariboisie`re, AP-HP, Paris, France, 2 Department of Vascular Imaging, Hoˆ pital Lariboisie`re, AP-HP, Paris, France, 3 Department of Anaesthesiology and Critical Care, Hoˆ pital Lariboisie`re, AP-HP, Paris, France, 4 Department of Nuclear Medicine, Hoˆ pital Lariboisie`re, AP-HP, Paris, France, 5 Department of Genetic Medicine and Obstetrics and Gynecology, Weill Cornell Medical College, Paris, France Abstract Background: The objective of this study was to assess efficacy and determine the optimal indication of selective arterial embolisation (SAE) in patients with life-threatening post-partum haemorrhage (PPH). Methodology/Principal Findings: One hundred and two patients with PPH underwent SAE and were included from January 1998 to January 2002 in our university care center. Embolisation was considered effective when no other surgical procedure was required. Univariate and multivariate statistical analysis were performed. SAE was effective for 73 patients (71.5%), while 29 required surgical procedures. SAE was effective in 88.6% of women with uterine atony that was associated with positive outcome (OR 4.13, 1.35–12.60), whereas caesarean deliveries (OR 0.16, 0.04–0.5) and haemodynamic shock (OR 0.21, 0.07– 0.60) were associated with high failure rates, 47.6% and 39.1%, respectively. Conclusions/Significance: Success rate for SAE observed in a large population is lower than previously reported. It is most likely to succeed for uterine atony but not recommended in case of haemodynamic shock or after caesarean section. Citation: Touboul C, Badiou W, Saada J, Pelage J-P, Payen D, et al. (2008) Efficacy of Selective Arterial Embolisation for the Treatment of Life-Threatening Post- Partum Haemorrhage in a Large Population. PLoS ONE 3(11): e3819. doi:10.1371/journal.pone.0003819 Editor: Pisake Lumbiganon, Khon Kaen University, Thailand Received May 10, 2008; Accepted November 2, 2008; Published November 26, 2008 Copyright: 2008 Touboul et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. * E-mail: jat2021@qatar-med.cornell.edu . These authors contributed equally to this work. Introduction Post-partum haemorrhage (PPH) occurs in 2–11% of deliveries, remains a major cause of maternal mortality and morbidity, despite advances in obstetrics and intensive care.[1,2] In developed countries, life-threatening PPH occurs in 1 per 1000 deliveries;[3–5] it is the main cause of maternal mortality in France, responsible for more than 20 of the 80 maternal deaths each year [1,2]. Prevention and rapid identification of the source and control of the bleeding are essential to prevent maternal morbidity and mortality [6,7]. In most cases PPH can be managed medically with such uterotonic drugs as oxytocin or prostaglandin analogues [4,8]. When medical treatment remains insufficient, three therapeutic options are available. The two standard alternatives are vascular ligature (e.g., of the hypogastric or uterine arteries) [3,9], with success rates ranging from 40% to 100% [10–15], and emergency hysterectomy, which is the treatment of last resort for PPH [3]. Selective arterial embolisation (SAE) of the uterine arteries was recently proposed as an alternative to surgery, and success rates for controlling severe PPH with it are reported to range from 85% to 95% [13,16]. Its benefits seem to include a low complication rate and the avoidance of the risks of surgery and general anaesthesia in haemodynam- ically unstable patients [13,17]. The studies evaluating SAE so far, however, have two major methodological drawbacks: relatively few patients (9 to 35) and imprecise descriptions of the severity of the PPH and of the patients’ general status [13,16]. The aim of our study was to assess the efficacy and determine the optimal indication for SAE in the management of severe life- threatening PPH in a large population. Methods Objectives The objective of our study was to assess the efficacy and determine the optimal indication for SAE in a large population of patients with severe life-threatening PPH. Participants This study included all women who had life-threatening primary PPH and underwent SAE in our university teaching hospital from January 1998 through January 2002. They either gave birth in our obstetrics department or were transferred from PLoS ONE | www.plosone.org 1 November 2008 | Volume 3 | Issue 11 | e3819