title: Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review.
abstract: OBJECTIVE
  Arterial embolisation (AE) plays a major role in current practice in the management of postpartum haemorrhage (PPH) that fails to respond to conservative treatment. While its benefit is well known, long-term outcomes of AE have been poorly investigated. The objective of this review is to assess its potential complications and long-term effects on the patients' quality of life.
  
  
  METHODS
  Using the terms "embolisation" and "postpartum haemorrhage", we searched the Cochrane Central Register of Controlled Trials, Medline and PubMed for published studies. We limited the search to articles in English and French reporting "complications", "fertility", "menstruation" or "menstrual cycle" in humans. To ensure completeness, the references of extracted articles and review articles were also searched.
  
  
  RESULTS
  The fertility rate in patients attempting another pregnancy reaches 70-80 %. Pregnancies following AE for PPH are not associated with a higher rate of intrauterine growth restriction. Pathological placentation (placenta accreta/increta/percreta) occurs more frequently after AE than in the general population. Psychological wellbeing, post-traumatic stress and sexual dysfunction after a life-threatening PPH requiring AE will require further investigation.
  
  
  CONCLUSIONS
  AE does not appear to adversely affect menstrual cycle, fertility and subsequent pregnancies, but may affect placentation. The experience of a life-threatening PPH, however, might prevent couples from pursuing another pregnancy.
  
  
  CONCLUSIONS
  • Embolisation for PPH does not adversely affect menstrual cycle and fertility • Experience of life-threatening PPH might prevent couples from pursuing another pregnancy • Pathological placentation seems to occur more frequently after embolisation for PPH.
authors.affiliation: Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.|Department of Radiology, University Hospital, 1011, Lausanne, Switzerland.
authors.forename: Marie-Aimée Päivi
authors.initials: MP
authors.lastname: Soro
authors.affiliation: Department of Radiology, University Hospital, 1011, Lausanne, Switzerland.
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.affiliation: Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
authors.forename: Maud
authors.initials: M
authors.lastname: de Rham
authors.affiliation: Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland. david.baud@chuv.ch.
authors.forename: David
authors.initials: D
authors.lastname: Baud
mesh_terms: D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004716:Endometritis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology; D010921:Placenta Accreta / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011788:Quality of Life; D014591:Uterine Diseases / Q000453:epidemiology* / Q000209:etiology; D014599:Uterus / Q000473:pathology*; D057772:Vascular System Injuries / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology*
keywords: Complication; Embolisation; Fertility; Post-traumatic stress; Postpartum haemorrhage (PPH)