Background: Primary postpartum hemorrhage (PPH) remains one of the main causes of maternal morbidity and mortality worldwide. Selective bilateral uterine artery embolization has been used since the 1970s for the conservative treatment of PPH. Case: A gravida 10, para 0, 41-year-old woman with twins of 35-weeks' gestation admitted for vaginal bleeding was diagnosed for placenta accreta by ultrasound (US) and magnetic resonance imaging (MRI). Delivery was performed by cesarean section. Preoperatively, the complications and risks associated with this potential diagnosis, including hysterectomy, were discussed with the patient. Bearing in mind the patient's desire to preserve her uterus, the placenta accreta was partially removed. However, because of severe bleeding and hemodynamic instability, the patient was referred to the vascular interventional radiology unit for intraoperative transcatheter arterial embolization (TAE). As standard procedures had failed to achieve full hemostasis, a new embolic agent “Onyx” (ev3, Irvine, CA) was used. Hemostasis was achieved, and hemodynamic stability continued without further complications. Conclusions: This is believed to be the first report in the obstetrics and gynecology literature of uterine embolization with Onyx for the management of severe postpartum hemorrhage. (J GYNECOL SURG 28:309)
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