Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage.
OBJECTIVE
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.


METHODS
Retrospective study.


METHODS
University-affiliated tertiary referral centre.


METHODS
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.


METHODS
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.
Sentilhes
Loïc
L
Department of Obstetrics and Gynaecology, Rouen University Hospital, Charles Nicolle, Rouen, France. loicsentilhes@hotmail.com
Gromez
A
A
Clavier
E
E
Resch
B
B
Verspyck
E
E
Marpeau
L
L
D000328:Adult; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006175:Gynatresia / Q000209:etiology; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D010921:Placenta Accreta / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D055502:Secondary Prevention; D000267:Tissue Adhesions / Q000209:etiology; D055815:Young Adult