A 25-years woman P2L2 with previous 2LSCS was referred to our institute with c/o bleeding per vagina with clots. History of LSCS done 20days back in Holakere and delivered a single live term male baby of weight 2.8 kgs. post-natal events are uneventful. Patient was discharged after 5 days. Now she presented with above complaints on examination uterus contracted well, nontender, lscs scar healthy.

Per speculum examination massive bleeding with clots present. Estimated blood loss of > 1000 ml per vaginal examination clots presents os closed. On USG uterus size 10.1*4.9*6.2 cm, it showed no RPOC with mild subcutaneous edema along the suture line. She was treated with I.V antibiotics, oxytocics 3. PRBC transfusion done and was discharged after 3 days. She was stable at the time of discharge and no per vaginal bleed. 15 days later she presented with 2^nd episode PPH in shock with estimated blood loss of >1500ml. On examination uterus contracted well, clots present, cervical os closed. After patient is stabilized USG 8.5*6.6*3.5cm and MRI is done, was normal. Under sedation endometrial Curratage done which revealed endometritis in HPE report. She was treated with IV antibiotics, uterotonics and 2PRBC transfused. Discharged after 10 days. 3 days later she came with 3^rd episode PPH with estimated blood loss of 200 ml. Treated with uterotonics and was referred to Bangalore for uterine artery embolization. Patient is being followed up at BMCH & is stable.

PPH is an acute haemostatic vascular disorder in 5% of all deliveries. Most common causes of secondary PPH are RPOC, uterine sub involution, abnormally invasive placentation, and coagulopathies. Patients usually presents with vaginal bleeding out of proportion to the expected bleeding in postpartum period. Treatment modalities are conservative management with uterotonic durgs, vaginal packing and surgical repair of lacerations. Surgical ligation of uterine arteries and internal iliac arteries when it is not controlled by conservative management. Hysterectomy is performed when all other measures fails 3, 4.

Recently embolization has been proposed as an alternative treatment. The first reported trans catheter arterial embolization of PPH was described by Brown et.al in 1979. Several studies reported high success rates of embolization with fewer complications. In last 20years, more than 110 cases have been reported in the literature. Preservation of uterus remains an indisputable advantage of uterine embolization and pregnancies have been reported after pelvic embolization. Success rate of uterine artery embolization is 96% 3, 4.

Uterine artery embolization is recommended safe and effective alternative to hysterectomy in PPH 3 due to its characteristics of fast pace, excellent effect, wide indication, minimal invasiveness, and uterine preservation.