Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage

Descargues, G; Tinlot, F. Mauger; Douvrin, F.; Clavier, É.; Lemoine, Jean; Marpeau, L.

doi:10.1093/humrep/deh082

Cited by 104 publications

(60 citation statements)

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“…Several studies demonstrated normal menses and pregnancies in women after arterial embolization. 16,[36][37][38] The fi ndings of the present study, though limited to a small number of subjects, support the benefi cial effects of arterial embolization with an adequately sized gelatin sponge for preserving reproductive function.…”

Section: Group 2: Prophylactic Catheterization For Anticipated Postpasupporting

confidence: 73%

Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

et al. 2008

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Section: Group 2: Prophylactic Catheterization For Anticipated Postpasupporting

confidence: 73%

Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

et al. 2008

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“…Nonetheless, the radiation exposure appears to be comparable with that of routine diagnostic imaging procedures [32]. In one study [33], 10 pregnancies occurred in 25 patients after embolization therapy for postpartum hemorrhage. Those authors concluded that women who undergo arterial embolization for obstetric hemorrhage can preserve their fertility and have successful uneventful pregnancies.…”

Section: Discussionmentioning

confidence: 96%

Pregnancy After Uterine Artery Embolization for Symptomatic Fibroids: A Series of 15 Pregnancies

Firouznia

Ghanaati

Sanaati³

et al. 2009

American Journal of Roentgenology

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[12,13], and cervical ectopic pregnancy [14][15][16] has been reported.The effects of embolization on ovarian function are important when preservation of fertility is desired. Few articles have focused on the effect of UAE for fibroids and its outcome on future fertility and pregnancy. To the best of our knowledge, pregnancy after UAE has been described in the literature in the form of case reports [17][18][19][20], a review article [21], and retrospective reports of case series [22][23][24][25][26][27][28][29]. As of March 2008, more than 170 patients worldwide had become pregnant after UAE. At a university-affiliated referral hospital in Iran, we evaluated the pregnancies of women who underwent UAE for symptomatic fibroids and desired to become pregnant. Subjects and Methods From Wo m e n's I m ag i ng • O r ig i n a l R e s e a rc h Uterine fibroids are among the most common benign tumors of the female pelvis that cause abnormal menstrual bleeding. Uterine artery embolization (UAE) in the management of uterine myomas was first reported by Ravina et al. in 1995 [1]. Their promising results were confirmed in several uncontrolled cohort studies, which showed an approximately 50% decrease in uterine volume and relief of symptoms in 80-90% of patients [2]. The advantages of UAE include lower cost and more rapid recovery than can be achieved with conventional therapies [3][4][5]. The efficacy of uterine embolization in the management of pelvic hemorrhage has been well documented in obstetrics and gynecology [6][7][8]. Successful pregnancy outcome after embolization for obstetric hemorrhage [9,10] Please see the commentary on this article, which appears on the following pages. W O M E N ' S I M A G I N G PROOF Copyrighted Material For Review Only • Not for DistributionPage Copy OBJECTIVE. The purpose of this study was to report on pregnancies and their outcome after uterine artery embolization for uterine fibroids. SUBJECTS AND METHODS. From 2001 to 2004, 102 patients (mean age, [± SD]35.7 ± 6.4 years; range, 20-48 years) with symptomatic uterine fibroids underwent uterine artery embolization with 500-to 710-µm polyvinyl alcohol particles. The mean uterine volume was 552 ± 649 cm 3 (range, 94-4,656 cm 3 ), and the dominant fibroid size was 228 ± 359 cm 3 (range, 14-2,618 cm 3 ) before the procedure. During the 2-year follow-up period, the patients were asked whether they were trying to achieve pregnancy and whether they were successful. We obtained pregnancy and obstetric records of the pregnant women from physicians' offices and hospitals.RESULTS. Among 102 women who underwent bilateral uterine artery embolization, 23 (22.5%) were seeking to become pregnant, and 14 of the 23 (61%) became pregnant, nine having been nulliparous. One patient had two pregnancies. Fourteen pregnancies were spontaneous, and one was achieved by zygote intrafallopian transfer. Two miscarriages occurred, one in the 12th and one in the 16th week of gestation. The other 13 pregnancies went to term, were uncomplicated, and ended in elective...

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“…All consecutive women with PPH who underwent embolisation as either the sole procedure (Group A) or in combination with uterine-sparing surgery (Group B) at our tertiary obstetric centre (Rouen University Hospital) between May 1994 and July 2007 were included in the study. The long-term maternal outcomes of the initial 28 participants treated between 1994 and July 1999 have been reported previously, 26 and the other women included up to July 2007 were added to the present study. The short-term maternal outcomes of these consecutive women have been reported previously in an earlier article.…”

Section: Methodsmentioning

confidence: 97%

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

Sentilhes

Gromez

Clavier

et al. 2009

BJOG

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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.

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Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage

Abstract: Our results suggest that women who undergo arterial embolization for obstetric haemorrhage should expect to have a return of normal menses with preservation of future fertility and successful uneventful pregnancies.

Cited by 104 publications

References 20 publications

Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

Arterial catheterization and embolization for management of emergent or anticipated massive obstetrical hemorrhage

Pregnancy After Uterine Artery Embolization for Symptomatic Fibroids: A Series of 15 Pregnancies

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage

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