Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage

Jérôme Delottea, Sébastien Novellasb, Charles Kohc, André Bongaina, Patrick Chevallierb
Received 12 February 2008; received in revised form 16 February 2009; accepted 24 March 2009. published online 15 April 2009.

Abstract
Post-partum hemorrhage is an obstetrical emergency.

Pelvic artery embolisation offers an alternative to surgical intervention and increases the rate of conservative treatment. The objective of this review was to study the scientific literature on obstetrical outcomes following uterine-sparing arterial embolisation performed for post-partum hemorrhage in a prior pregnancy.

A Medline and Sciencedirect search were performed in order to review all the French and English reports about pregnancy following pelvic arteries embolisation for post-partum hemorrhage.

Nineteen articles were identified and 13 were selected for inclusion. We have included the fertility follow-up of a total of 168 women who underwent pelvic arteries embolisation for post-partum hemorrhage. We highlight the clinical success of embolisation in 154 of the 168 patients (92%). Following the embolisation procedures, 7 hysterectomies were required and 4 patients died. Two of the 4 deaths occurred in women who were transferred from an outlying institution to a tertiary referral center.

In this population, 45 pregnancies were described. Among these pregnancies, 32 resulted in live births (71%), 8 were miscarriages (18%) and 5 patients carried out voluntary termination of pregnancy (11%). The cesarean section rate was 62%.

Post-partum hemorrhage occurred in 6 cases leading to 2 hysterectomies.

In conclusion, pelvic arterial embolisation offers a safe and conservative alternative to surgical interventions for post-partum hemorrhage in well-selected patients desiring to preserve future fertility.

Keywords: Embolisation, Post-partum hemorrhage, Fertility, Delivery, Pregnancy
a Obstetrics and Gynecology Unit, University Hospital, Archet II, Route St Antoine de ginestière, BP 3079 O6202 Nice Cedex 03, France
b Radiology Unit, University Hospital, Archet II, Route St Antoine de ginestière, BP 3079 O6202 Nice Cedex 03, France
c Reproductive Specialty Center, 2315 North Lake Drive, Milwaukee, WI 53211, USA
Corresponding author. Tel.: +33 4 920 36 105; fax: +33 4 920 36 563.

PII: S0301-2115(09)00234-6

doi:10.1016/j.ejogrb.2009.03.013

© 2009 Elsevier Ireland Ltd. All rights reserved.