Gynecological, reproductive and sexual outcomes after uterine artery embolization for post-partum haemorrage

Abstract

In this case control study, long-term gynecological, reproductive and sexual outcomes after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) were evaluated. The study was performed in a single referral hospital for PPH in Lausanne from 2003 to 2013. Each woman whose delivery was complicated by PPH and treated by UAE was included, and compared to a control group of women whose delivery was uncomplicated. Cases were matched by maternal age, parity, ethnicity, year and mode of delivery, birth weight and gestational age in a 1–3 ratio. A total of 77 patients treated by UAE for PPH were identified in our obstetrical database. Among them, 63 were included and compared to 189 matched patients (no PPH). The mean interval time between UAE and this study was 8.1 years. Time to menstrual cycle recovery after delivery (3.9 vs 5.6 months, p = 0.66), spotting (7.9% vs 7.2%, p = 0.49), dysmenorrhea (25.4% vs 22.2%, p = 0.60) and amenorrhea (14.3% vs 12.2%, p = 0.66) were similar between the two groups. There was no difference in the FSFI score between the groups (23.2 ± 0.6 vs 23.8 ± 0.4; p = 0.41). However, the interval time to subsequent pregnancy was longer for patients after UAE than the control group (35 vs 18 months, p = 0.002). In case of pregnancy desire, the success rate was lower after UAE compared to controls (55% vs 93.5%, p < 0.001). The rate of PPH was higher in those with previous PPH (6.6% vs 36.4%, p = 0.010). Patients treated by UAE for PPH did not report higher rates of gynecological symptoms or sexual dysfunction compared to patients with uneventful deliveries. The inter-pregnancy interval was increased and the success rate was reduced. In subsequent pregnancies, a higher rate of PPH was observed in those that underwent UAE.

Paternal and maternal long-term psychological outcomes after uterine artery embolization for severe post-partum hemorrhage

“…As shown in our previous paper 14 describing the same cohort of patients, maternal age (33 years old), gestational age at birth (38 weeks), parity, birth weight, arterial pH, Apgar at 5 min were all similar between cases and controls.…”

“…A total of 63 cases (81.8%) were ultimately included in our study. Three matched controls (n = 189) were chosen for each case (n = 63) 14 .…”

“…With respect to their partners, 92 partners completed the questionnaires; 26/63 (41%) and 66/189 (35%) partners from patients with or without PPH, respectively (p = 0.37). The mean interval between the index delivery and response to the questionnaires was 8.1 years (95% confidence intervals [95%CI] 7.8-8.4) 14 . General socio-demographic variables were similar between both groups 14 .…”

“…The detailed methodology was described in a joined paper investigating gynecological, reproductive and sexual outcomes after UAE for PPH in the same population 14 . Briefly, we conducted a case control study using our obstetrical database of more than 30,000 patients, from the Maternity Unit of the Lausanne University Hospital (Switzerland) 15 .…”

“…Our primary outcome was the risk of depression and of PTSD symptoms, investigated through validated questionnaires (respectively MINI and TSQ). gynecological symptoms, sexuality, future fertility, and obstetrical outcomes were investigated in a previous study 14 . The study was approved by the Ethical Committee of the University and Hospital, Lausanne, Switzerland (protocol 55/13; date of approval 07.…”