Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases.
BACKGROUND
The guidelines advise arterial embolization in case of post-partum hemorrhage. We evaluated its feasibility and the subsequent fertility.


METHODS
A retrospective study has been conducted in our center for the past 10 years (1996-2005). Fifty-two patients experiencing a primary post-partum hemorrhage who were resistant to medical treatment underwent uterine artery embolization and/or hysterectomy. In case of arterial embolization, a follow-up of all the patients was realized, focusing on the preservation of fertility.


RESULTS
Six (11.5%) patients underwent hysterectomy straightaway and 46 (88.5%) arterial embolization in the first instance including 35 arterial embolizations after Cesarean section. Embolization was successful among 41 patients (89.1%) and hysterectomy was performed on the 5 (10.9%) others. Overall, 11/24 398 women suffered from a definitive loss of fertility after post-partum hemorrhage. Fertility was studied at least 1 year after the delivery. All patients had a return of normal menses. Sixteen of 41 women (39%) wanted another child and 100% succeeded. Nineteen pregnancies, including two twin pregnancy and one early spontaneous abortion were observed.


CONCLUSIONS
Embolization is a safe and effective non-surgical method to resolve post-partum hemorrhage and should be regarded as gold standard in a hemodynamically stable patient. Furthermore, subsequent fertility is not impaired by the procedure.
Chauleur
C
C
Department of Gynecology-Obstetrics, University Hospital NORD, F-42055 Saint-Etienne Cedex 2, France. celine.chauleur@chu-st-etienne.fr
Fanget
C
C
Tourne
G
G
Levy
R
R
Larchez
C
C
Seffert
P
P
D000328:Adult; D001158:Arteries; D002585:Cesarean Section / Q000009:adverse effects; D004621:Embolization, Therapeutic; D005260:Female; D005298:Fertility; D006801:Humans; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies