Impact of the new French clinical practice recommendations in embolization in postpartum and post-abortion hemorrhage: study of 48 cases.
OBJECTIVE
To evaluate the use of arterial embolization in postpartum hemorrhage (PPH) by comparing the indications, efficacy, times to diagnosis, treatment, and embolization, and conditions of management of patients before and after publication of the Collège National des Gynécologues et Obstétriciens Français clinical practice recommendations (CPR).


METHODS
Forty-eight patients who underwent embolization between January 2000 and December 2005 were included in a retrospective, descriptive, and comparative study. We compared the management before (n=21) and after (n=27) publication of the CPR. The main outcome measures were time to diagnosis of PPH, time to treatment initiation, time to decision to implement embolization, time to embolization, hemodynamic characteristics.


RESULTS
The number of embolizations has quadrupled since publication of the CPR, and the time taken to decide on embolization has been reduced by 30%. The success rate was 96%, there were no second embolization procedures, and one complication was recorded (hematoma of pubic symphysis). Hemodynamic status was better in patients treated after the CPR (P=0.003).


CONCLUSIONS
Embolization is an effective and safe technique, with a low complication rate. In our healthcare network, the decision to use embolization was faster since the CPR, embolizations have quadrupled, and patients' hemodynamic status has improved.
Mathe
Marie-Lise
ML
Service de Gynécologie Obstétrique C et Médecine Maternofoetale, CHU Arnaud de Villeneuve, Montpellier Cedex 5, France. p-boulot@chu-montpellier.fr
Morau
Estelle
E
Vernhet-Kovacsik
Hélène
H
Picot
Marie-Christine
MC
Boulot
Pierre
P
D000028:Abortion, Induced / Q000009:adverse effects*; D000328:Adult; D003657:Decision Making; D004621:Embolization, Therapeutic; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011364:Professional Practice / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors