Interventional radiology in the management of uncommon causes of obstetric haemorrhage

•Post-partum haemorrhage (PPH) is an obstetric emergency, accounting for more than 30% maternal deaths.•Secondary PPH includes haemorrhage after 24 hours of delivery and presents a management challenge.•Uncommon causes include RPOC, placental abruption/accreta, trauma, uterine AVM and gestational trophoblastic disease.•Interventional radiologists play a significant role in their management through a minimally invasive approach.•Both endovascular and percutaneous approach are minimally invasive, with high clinical success and minimal complications. To delineate the uncommon causes of pregnancy related haemorrhage and discuss various endovascular, and direct percutaneous interventional radiology techniques that can be used for successful management. Forty-four females with uncommon causes of pregnancy related haemorrhage, who were referred for uterine artery embolization, between January 2013 and May 2020, were retrospectively analyzed in this hospital-based study. Observations were tabulated under age, prior procedure, post procedure day, underlying pathology, route, embolizing agent used, complications and recurrence, and statistical analysis done. The mean age of the studied population was 28.5 ± 4.9 years (range 20–41 years), and the most common prior procedure performed was caesarean section (31.8 %), followed by post abortive procedures (29.5 %) and normal vaginal deliveries (27.3 %). The median post procedure duration was 6.5 days (range 1–80 days). Most common underlying pathology was pseudoaneurysm (31.8 %), followed by arteriovenous malformations and uterine artery hypertrophy (18.2 % each). Percutaneous route was used in 6 patients while the remaining 38 patients underwent endovascular management. Overall, Gelfoam was used in 50 % patients, gelfoam plus another agent in 29.5 % and glue in 20.5 % patients. Technical success was achieved in 97.7 % and clinical success in 95.4 % with no major procedure related complications. Interventional Radiology offers minimally invasive, safe and effective embolization procedures for the management of uncommon causes of pregnancy related haemorrhage, with low complication rate and high clinical success.