1471-0528/asset/BJO_left.gif?v=1&s=0fb87361cdb6be25fdf05019eed6d47f5143f610)
1471-0528/asset/olbannerright.gif?v=1&s=3892ef16ff18d6834c302faf85268a49f5fc588f)
Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage
Article first published online: 13 OCT 2009
DOI: 10.1111/j.1471-0528.2009.02381.x
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
Issue
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 117, Issue 1, pages 84–93, January 2010
Additional Information
How to Cite
Sentilhes, L., Gromez, A., Clavier, E., Resch, B., Verspyck, E. and Marpeau, L. (2010), Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 84–93. doi: 10.1111/j.1471-0528.2009.02381.x
Publication History
- Issue published online: 9 DEC 2009
- Article first published online: 13 OCT 2009
- Accepted 22 August 2009. Published Online 13 October 2009.
- Abstract
- Article
- References
- Cited By
Keywords:
- Intrauterine synechia;
- pelvic arterial embolisation;
- placenta accreta or percreta;
- postpartum haemorrhage;
- pregnancy
Objectives To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia.
Design Retrospective study.
Setting University-affiliated tertiary referral centre.
Population All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included.
Methods Data were retrieved from medical files and telephone interviews.
Main outcome measure(s) Fertility and pregnancy outcomes, synechia.
Results Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/percreta (P < 0.001) and postpartum fever above 38.5 °C (P = 0.04).
Conclusions Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman’s subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.