title: Outcome of pregnancies after pelvic artery embolization for postpartum hemorrhage: retrospective cohort study.
abstract: OBJECTIVE
  The effects of pelvic artery embolization (PAE) for postpartum hemorrhage (PPH) on subsequent pregnancies have been explored in small case series and one case-control study by mailed questionnaire with uncomplicated pregnancies as controls. We conducted a single-center retrospective cohort study using women with PPH without PAE for comparison.
  
  
  METHODS
  From a cohort of 103 women undergoing PAE for primary PPH between January 1999 and December 2012 (exposed) and 189 pregnancies with PPH not requiring PAE between January 2008 and December 2012 (unexposed), we queried the electronic medical records for readmissions to labor and delivery in subsequent years. Outcomes of subsequent pregnancies continuing past 20 weeks were obtained by chart review.
  
  
  RESULTS
  Repeat pregnancies were documented in 17 of 103 exposed women (16.5%) and 18 of 189 unexposed women (9.5%). At delivery complicated by PPH, the groups did not differ in demographics, gestational age, units of blood transfused, or PPH cause. At the time of subsequent deliveries, there was a greater interdelivery interval in women exposed to PAE than those unexposed (1710 ± 938 days vs 904 ± 358 days; P = .002), and the 2 groups were similar in terms of gestational age and birthweight. However, there was a significantly higher rate of placenta accreta in exposed than unexposed women (23.5 % vs 0%; P = .04), with 3 of 17 sustaining total abdominal hysterectomy and 1 requiring repeat PAE for severe PPH.
  
  
  CONCLUSIONS
  Pregnancies following PAE for PPH were more likely than those not receiving PAE for treatment to be complicated by placenta accreta. Pregnancies following PAE should be followed up for imaging evidence of placenta accreta.
authors.affiliation: The Brock Family Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA; School of Medicine, George Washington University Hospital, Washington, DC. Electronic address: sarah.poggi@inova.org.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Poggi
authors.affiliation: School of Medicine, George Washington University Hospital, Washington, DC.
authors.forename: Andrew
authors.initials: A
authors.lastname: Yaeger
authors.affiliation: Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC.
authors.forename: Yesmean
authors.initials: Y
authors.lastname: Wahdan
authors.affiliation: The Brock Family Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA; Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ghidini
mesh_terms: D000328:Adult; D001721:Birth Intervals; D001724:Birth Weight; D016022:Case-Control Studies; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D010388:Pelvis / Q000098:blood supply*; D010921:Placenta Accreta / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
keywords: pelvic artery embolization; placenta accreta; postpartum hemorrhage