Background: Postpartum hemorrhage is the leading cause of severe maternal morbidity and death. A prompt management of Uterine Artery Embolization (UAE) is important for a good outcome. UAE is generally accepted to be a safe and reliable procedure.Objective: To estimate critical patient characteristics influencing the success of UAE for the treatment of emergent primary postpartum hemorrhage.Materials and Methods: This was a cross sectional study that reviewed 121 patients who were diagnosed primary postpartum hemorrhage between February 2002 and December 2009 at a tertiary treatment center among 4,022 deliveries. We evaluated patient clinical characteristics associated with a successful surgical outcome of UAE. Results: The success rate for UAE was 96%. For two cases, UAE complication was associated with fever (>38.5oC). Five patients had problems that required admission to the intensive care unit (ICU).Conclusion: To increase the surgical success rate and lower the number of ICU admissions, the decision to treat primary postpartum hemorrhage using UAE should be based on individual patient clinical findings under the direction of obstetrics staff and an interventional radiologist.

Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity, especially in developing countries, and a major cause of direct maternal death worldwide. Considering the importance of timely postpartum hemorrhage management and access to low-risk methods, assessing the efficacy of Uterine Artery Embolization (UAE) is essential. Therefore, the present study was conducted to evaluate the success rate and outcomes of UAE in the treatment of delayed postpartum hemorrhage.Materials & Methods: This cross-sectional study was performed on women with delayed postpartum hemorrhage who were referred to the gynecology and obstetrics clinic of a referral hospital in Urmia city under treatment of UAE. The census method was used for choosing the patients and all women with delayed postpartum hemorrhage between April 2019 and March 2020 were entered into the study.Results: During the study period, he number of 22 women with delayed postpartum hemorrhage were entered into the study. The mean age of the women was 29.36±5.09 years. The success rate of UAE was 95.6%. The number of 20 (90.9%) cases did not report complications. For one case, UAE complication was associated with amenorrhea and for the other one with vaginal bleeding.Conclusion: The results showed that the UAE method as an effective method with high efficacy and low complications can be considered a suitable choice for the treatment of delayed postpartum hemorrhage.

Introduction: Uterine Artery Embolization (UAE) is a well-established treatment option for symptomatic Uterine leiomyomas. In cases where the internal iliac Artery, from which the Uterine Artery normally originates, is ligated, blood flow to the uterus can be preserved through various collateral vessels. Here, we report a case of a 44-year-old patient who underwent UAE via collateral branches of the right lumbar Artery due to a history of kidney transplantation. Case Presentation: A 44-year-old patient was referred for UAE for leiomyomas. She had a history of kidney transplantation with right internal iliac Artery to graft renal Artery anastomosis performed using the end-to-end method. The right Uterine Artery was successfully embolized through collaterals from the right lumbar Artery, resulting in a positive outcome. Conclusion: We present a case in which collateral circulation was recruited during UAE in a patient with absent unilateral internal iliac Artery flow due to prior kidney transplantation.

Background and Aim: Uterine arteriovenous malformations (AVM) is a rare congenital or acquired condition, mostly seen in the multiparous and women of reproductive age. Acquired Uterine arteriovenous malformations occurs following trauma, Uterine instrumentation, infection, abortion or gestational trophoblastic disease. Treatment of Uterine arteriovenous malformations is based on different clinical conditions of the patient and includes drug, blood transfusion, Uterine Artery Embolization and hysterectomy. In this article we report Uterine Artery Embolization in a woman with Uterine arteriovenous malformations 6 weeks after spontaneous abortion. Case report: A 39-year-old woman, gravida 3 and para 2, referred to our clinic with complaint of bleeding. 173 days ago, the patient had history of spontaneous abortion at the 6th week of pregnancy. After sonography, Uterine Artery malformation was diagnosed. Due to repeated bleeding and also due to mother's desire to preserve fertility, Uterine Artery Embolization was performed. Conclusion: In abnormal Uterine bleeding after abortion, it is necessary to perform color doppler sonography to rule out Uterine Artery malformation and Embolization is the first and best treatment option for the women who want to preserve fertility.

Background/Objectives: To evaluate the safety, efficacy and complication rate of Uterine Artery Embolization in symptomatic fibroid patients in Iran.Patients and Methods: A hundred and two patients aged 20-48 years (mean age: 35.7 ±6.4 years) with symptomatic fibroids entered the study from September 2001 to November 2004. The most common presenting symptom was increased menstrual bleeding, which occurred in 74.5% of all patients. Urinary symptoms occurred in 43%, and bulk-related symptoms were seen in 63.7 % of our patients.We performed bilateral UAE (Uterine Artery Embolization) using PVA (polyvinyl alcohol) particles (500-710 micron) and assessed the patients before UAE and at regular follow- ups at 1, 3, 6 and 12-month intervals by questionnaires / interviews and ultrasound. MRI without gadolinium (Gd-DTPA) injection was done before Embolization and at 6 and 12 months after the cedure.Results: By Friedman test, sequential follow-up (up to 12 months) showed that the vaginal bleeding severity significantly decreased (p <0.0001), with menorrhagia resolving in 59.4% of patients at 1 month, and in 69% at 12 months. The mean uterus volume decreased 38.5 ±30% after 12 months .The paired t-test showed that dominant fibroid volume changed from 273.7±439.2 cm3 to 112.1±141.6 cm3 at month 6 (n=58, p=0.001 ) and from 246.1±314.5 cm3 to 70.1±73.5 cm3 at month 12 (n=41, p<0.0001 ). The initial size of the fibroids did not affect the success rate.Conclusion: The study showed the high efficacy of UAE in controlling fibroid related symptoms, with only few complications.

Uterine fibroids are commonly asymptomatic. They often cause pelvic pain, abnormal and increased vaginal bleeding, etc. Traditional treatment of symptomatic Uterine fibroids was trans-abdominal hysterectomy. Nowadays, Uterine Artery Embolization (UAE), also called Uterine fibroid Embolization, is considered as a safe and highly-effective nonsurgical treatment for women with symptomatic Uterine fibroid tumors. Advantages of UAE over conventional hormonal suppression and surgical procedures include avoidance of the side effects of drug therapy and surgery-related physical and psychological trauma. These patients commonly resume their normal activities within a week after the procedure; weeks earlier than that for trans-abdominal hysterectomy. Over the past 30 years, interventional radiologists have done UAE for treatment of emergency Uterine bleeding. Since 1995, interventional radiologists have turned their attention to treatment of Uterine fibroids with a similar procedure. The first fibroid Embolization in Iran was done approximately three years ago. So far, more than 100 cases have been treated by this method and it is going to be quickly accepted as a safe alternate for surgery.

Introduction: Severe vaginal bleeding after postpartum is an emergency in obstetrics and if not treated appropriately associated with high mortality. Uterine Artery Embolization is a minimally invasive procedure and effective method in addition to control bleeding, moreover may also preserve fertility. However, this method is also associated with complications such as ischemia and Uterine rupture. The aim of this article is to report of a case of necrosis and rupture of the uterus following Uterine Artery Embolization.Case report: A 23-year-old woman with clinical presentation of massive postpartum hemorrhage was referred. She had history of twice Cesarean section and suffered severe vaginal bleeding after last surgery. Uterine Artery Embolization was performed and following it, because of repeated and uncontrolled vaginal bleeding, inevitably explorative laparotomy was performed. During surgery due to rupture of the myometrium and the impossibility of its restoration, she underwent hysterectomy. Pathology report confirmed the diagnosis.Conclusion: Despite the effective beneficial outcomes of Uterine Artery Embolization, due to its complications, proper indication and careful attention should be considered.

Uterine fibroids are benign tumors occurring in 20-50% of women in their reproductive age. They are the most frequent indication for hysterectomy at Pre-menopausal age. Fifty percent of fibroids are asymptomatic and require no treatment, but the rest may cause menorrhagia, dysmenorrhoea, dyspareunia, abdominal distension, pressure effects, pregnancy loss and infertility. Unfortunately all the primary treatments for fibroma, (including hysterectomy, myomectomy and hormonal therapy) have substantial disadvantages. Hysterectomy has the risks associated with major surgical procedures and eliminates fertility. Besides, the psychological aspects of Uterine sacrifice are significant. Myomectomy also has similar risks, with approximately 20-25% recurrence of symptoms. Hormonal therapy is effective in the short term, and is associated with side-effects such as hot flashes, mood swings, insomnia and dyspareunia. 4 Uterine Artery Embolization (UAE) as a primary therapy for fibroids was reported for the first time by Ravina in 1995. larger studies then confirmed the safety and efficacy of this technique. The clinical success rate has beenreported at 80-94%. The mean decrease in Uterine volume varies from 35% to 48%, and fibroid size varies in the range of 45-78 %. Our university affiliated hospital is currently the main referring center that has been applying UAE for symptomatic fibroids since September 2001 in our country. In this study, we report our experience with the Embolization of fibroids in a population of Middle- Eastern women and compare the outcome with the studies from western nations.Discussion: The average reduction in the volume of the fibroid and the mean Uterine size comply well with many other reports (p=0.93). Menorrhagia in Georgetown’s 200 patients showed improvement in 87% at month 3 and 89% at month 6. Similar results were reported by Hutchins and Worthington -Kirsch; in their report, menstrual improvement occurred in 85% after 6 months, which supports our results (p=0.4). Improvement of urinary symptoms by UAE was approximately 87% after six months, and improvement of bulk- related symptoms was 93 %; very similar to other reports. The results from the published series and those of our patients are similar in the degree of symptom improvement, but fibroid shrinkage after UAE shows much better results in our patients than many other reports. Although for patients with a desire for future pregnancy we only included patients who were candidates for extensive myomectomy or hysterectomy, the average age of our patients was lower than many other studies. Our technical success rate was slightly lower than other studies. This might due to by the unilateral Uterine Artery Embolization in 11 patients at the beginning of our experience. It shows that the failure rate has a linear correlation with the experience of the radiologist. No serious complication occurred after UAE in our patients. We did not have any mortality in our patients. The major adverse effect following UAE was pain, which was controlled by pethidine or morphine sulfate. It is therefore important to forewarn women about the pain they will experience, and which will probably last for several days. Several reports have described the relationship between improvement in menorrhagia and primary tumor size. Katsumori et al. reported that improvement in menorrhagia was unrelated to initial Uterine size. Spies et al. reported that bleeding outcome demonstrated a trend toward improvement with smaller baseline Uterine and fibroid volumes. In our study, the improvement in menorrhagia at one year after Embolization had no association with the primary size of fibroids. Our study confirms that clinical success after bilateral Uterine Artery Embolization is not related to the size of the fibroid. However, we did not perform Embolization in patients with fibroids larger than 2618 cm3. Katsumori demonstrated that there was no statistical difference between fibroid volume reduction rate two groups of patients with fibroids maller and larger than 10 cm. Spies et al. reported that smaller baseline fibroid size is more likely to result in a positive imaging outcome. In our study, similar to Katsumori, there was no statistical difference between baseline fibroid volume and reduction in fibroid size after one year. UAE has several potential advantages over hysterec-tomy, myomectomy and hormonal suppression. Unlike myomectomy or hysterectomy, UAE involves virtually no complications of major surgery. Recovery time is several weeks shorter than with hysterectomy or open myomectomy (7 days versus 6 weeks). Early menopause-like symptoms, which are often seen with GnRH therapy, are rarely induced as a result of UAE. UAE has the advantages of allowing preservation of Uterine function (i.e., normal menses and even pregnancy). In addition, the patients do not suffer the psychological problems of Uterine sacrifice. The procedure is well tolerated by patients. A clinical advantage is that if UAE fails, the full range of other options for treatment of fibroma will be still available. And if necessary, surgery will be easier and safer because of the preoperative Embolization. Hysterectomies have higher facility costs than UAE because of longer hospital stay, procedure duration and recovery time. One of the disadvantages associated with UAE is that it is currently somewhat difficult for women to learn about the procedure or its accessibility in their area. Some gynecologists may be unfamiliar with it or may counsel the patients to stay with the tried and trusted surgical procedures. According to our results, we can conclude that UAE is a safe and effective method in treatment of Uterine fibroids. This conclusion has been approved in other reports too. However, there are a number of additional questions that require further studies. For example, the long-term effects on ovarian function and future fertility are yet to be determined. Successful pregnancy after this procedure has been reported but as of yet, the pregnancy rate cannot be calculated because it is not known how many patients treated with UAE have attempted to become pregnant. It is likely that a large multi-centric long-term study will be required to answer these questions.

Background: Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of Uterine bleeding can be lead to massive hemorrhage.Case: We describe here a case of Uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of Uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The Embolization of bilateral Uterine arteries was performed successfully.Conclusion: Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter Uterine Artery Embolization offers a safe and effective treatment.