Document Detail


Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage.
MedLine Citation:
PMID:  19832826     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 degrees 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.
Authors:
Lo?c Sentilhes; A Gromez; E Clavier; B Resch; E Verspyck; L Marpeau
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  117     ISSN:  1471-0528     ISO Abbreviation:  BJOG     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-02-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  84-93     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynaecology, Rouen University Hospital, Charles Nicolle, Rouen, France. loicsentilhes@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Embolization, Therapeutic / adverse effects*
Female
Gynatresia / etiology
Humans
Infertility, Female / etiology
Placenta Accreta / etiology
Postpartum Hemorrhage / therapy*
Pregnancy
Pregnancy Outcome
Recurrence / prevention & control
Risk Factors
Tissue Adhesions / etiology
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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