Korea is facing a serious issue in maintaining its population due to the recent fall in birth rate and a quickly-aging population. As postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality, we analyzed the current status and treatment of PPH in Korea. Most PPHs are treated successfully with uterus contrating agents. However, a small portion of PPH do not respond to drugs and require a more definitive treatment such as hysterectomy or uterine artery embolization (UAE). UAE has the advantage of preserving fertility with acceptable safety and efficacy profiles.

We analyzed the efficacy and safety of UAE using claims data from the Health Insurance Review and Assessment Service (HIRA), cohort data from a tertiary hospital, systematic review and meta-analysis of the literature using data from Korea, and extensive review of providers working at each level of care.

Analysis of the 2008 HIRA data revealed that the incidence of PPH was about 4%, with more than 18000 cases. The vast majority of cases were treated with drugs, but approximately 500 cases were treated with either UAE or hysterectomy. The incidence of PPH increased with the age of the delivering mother. PPH was also more

frequent after births that occurred in smaller hospitals. There was a great variation in the treatment received after PPH occurred and the proportion between UAE and hywterectomy according to the region where PPH occurred.

The cohort study of a tertiary hospital and the meta-analysis confirmed previous reports of safety and efficacy of UAE. Interviews with first-line providers and physicians working at hospitals capable of performing UAE suggested that the formation of a strong network between clinics/small hospitals and tertiary hospitals capable of UAE was critical to facilitating the use of UAE in PPH patient stable enough to receive the treatment.