Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study

Abstract

Embolization in post-partum haemorrhage appears to be a safe procedure that does not impair subsequent menstruation and fertility. Recurrence of severe post-partum haemorrhage may occur at subsequent deliveries.

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

“…Our study, which reports the largest number of pregnancies (n = 26) and full-term pregnancies (n = 19), confirms the results reported previously in the literature. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Contrary to our study, the majority of these case series, which have been published previously, did not use a systematic approach to follow-up and telephone contact with participants in an attempt to address subsequent fertility and obstetric outcome. Therefore, they did not 100 women eligible for inclusion in the study* 15 women encountered exclusion criteria peripartum hysterectomy (n = 9) performed before embolization (n = 2) after embolization (n = 7) embolization of vaginal arteries alone (n = 6) assess accurately the fertility outcome as they did not take into consideration the evaluation of desire and attempts to conceive.…”

“…Nevertheless, these 14 case series, in addition to our study, document a total of 113 pregnancies. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Of the 92 pregnancies that did not end during the first trimester, all resulted in full-term delivery of a healthy eutrophic child. Nevertheless, in 16 pregnancies (17.4%), a recurrence of PPH occurred.…”

“…Of the 13 vaginal deliveries, uterine atony was responsible for the recurrence of PPH in four pregnancies, requiring local procedures (manual removal of placenta, exploration of genital tract, uterine massage) and prostaglandins to stop haemorrhage in three (cases 1,11,14) and embolisation in one (case 3). In the six caesarean deliveries, recurrence of PPH occurred in two, both caused by placenta accreta (cases 17 and 18).…”

“…8 Primary long-term studies suggest that uterine-sparing surgical procedures do not appear to impair subsequent fertility and pregnancy outcomes. [7][8][9][10] Previous studies of women undergoing embolisation have suggested that it does not impair subsequent fertility, [11][12][13][14][15][16][17][18][19][20][21][22][23][24] but the cohort, methodology and follow-up rate of these small case series are limited. 25 Moreover, in the majority of case series, no information is available regarding women with presumed preserved fertility and desire for pregnancy who do not become pregnant.…”

Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines

“…The menstrual cycle resumes in 91-100 % of patients who have undergone emergency TAE [1,11,15,17,20,[35][36][37][38][39]. Pregnancy can be expected in 69-100 % (average, 79 %) of women who desire future pregnancy [35].…”