Skip to main content
Top
Published in: Japanese Journal of Radiology 3/2020

01-03-2020 | Fertility | Original Article

Uterine artery embolization for postpartum and postabortion hemorrhage: a retrospective analysis of complications, subsequent fertility and pregnancy outcomes

Authors: Masafumi Toguchi, Yuko Iraha, Junji Ito, Wataru Makino, Kimei Azama, Joichi Heianna, Fumikiyo Ganaha, Yoichi Aoki, Sadayuki Murayama

Published in: Japanese Journal of Radiology | Issue 3/2020

Login to get access

Abstract

Purpose

To evaluate the impact of UAE for postpartum and postabortion hemorrhage on future infertility, especially in patients undergoing infertility treatment, along with angiographic endpoints.

Materials and methods

Sixty-two sessions performed emergent or prophylactic UAE for postpartum or postabortion hemorrhage between 2008 and 2017 were selected. Subsequent pregnancy outcomes and complications were investigated as primary outcomes. The cases were divided into two groups based on the presence of massive hemorrhage. The relationships between angiographic endpoints and complications were also evaluated as secondary outcomes.

Results

The mean patient age was 34.1 ± 6.5 years. Fourteen of the 23 patients (60.9%) with desired fertility achieved pregnancy and 10 patients achieved live births (43.5%). In the patients during infertility treatment, three of the four patients had complications of severe adhesion after caesarean section or placenta accreta. In the group of patients with massive hemorrhage, the occurrence of uterine infection was significantly high (p = 0.014), but the angiographic endpoints were not significant, regardless of the occurrence of uterine infection.

Conclusion

It was unnecessary to modify embolic endpoint according to seriousness of the hemorrhage. The pregnancy and live birth rates were acceptable, although patients undergoing infertility treatment had a higher rate of delivery complications.
Literature
1.
go back to reference Inoue S, Masuyama H, Hiramatsu Y, Multi-Institutional Study Group of Transarterial Embolization for Massive Obstetric Haemorrhage in Chugoku, and Shikoku Area Society of Obstetrics, and Gynecology. Efficacy of transarterial embolisation in the management of post-partum haemorrhage and its impact on subsequent pregnancies. Aust N Z J Obstet Gynaecol. 2014;54:541–5.CrossRef Inoue S, Masuyama H, Hiramatsu Y, Multi-Institutional Study Group of Transarterial Embolization for Massive Obstetric Haemorrhage in Chugoku, and Shikoku Area Society of Obstetrics, and Gynecology. Efficacy of transarterial embolisation in the management of post-partum haemorrhage and its impact on subsequent pregnancies. Aust N Z J Obstet Gynaecol. 2014;54:541–5.CrossRef
2.
go back to reference Hovsepian DM, Siskin GP, Bonn J, Cardella JF, Clark TW, Lampmann LE, et al. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata; CIRSE and SIR Standards of Practice Committees. J Vasc Interv Radiol. 2009;20:S193–S199199.CrossRef Hovsepian DM, Siskin GP, Bonn J, Cardella JF, Clark TW, Lampmann LE, et al. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata; CIRSE and SIR Standards of Practice Committees. J Vasc Interv Radiol. 2009;20:S193–S199199.CrossRef
3.
go back to reference Gaia G, Chabrot P, Cassagnes L, Calcagno A, Gallot D, Botchorishvili R, et al. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol. 2009;19:481–7.CrossRef Gaia G, Chabrot P, Cassagnes L, Calcagno A, Gallot D, Botchorishvili R, et al. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol. 2009;19:481–7.CrossRef
4.
go back to reference Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003;18:849–52.CrossRef Salomon LJ, deTayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, et al. Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod. 2003;18:849–52.CrossRef
5.
go back to reference Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG. 2010;117:84–93.CrossRef Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L. Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage. BJOG. 2010;117:84–93.CrossRef
6.
go back to reference Kim HS, Tsai J, Lee JM, Vang R, Griffith JG, Wallach EE. Effects of uteroovarian anastomoses on basal follicle stimulating hormone level change after uterine artery embolization with trisacryl gelatin microspheres. J Vasc Interv Radiol. 2006;17:965–71.CrossRef Kim HS, Tsai J, Lee JM, Vang R, Griffith JG, Wallach EE. Effects of uteroovarian anastomoses on basal follicle stimulating hormone level change after uterine artery embolization with trisacryl gelatin microspheres. J Vasc Interv Radiol. 2006;17:965–71.CrossRef
7.
go back to reference Hehenkamp WJ, Volkers NA, Broekmans FJ, de Jong FH, Themmen AP, Birnie E, et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod. 2007;22:1996–2005.CrossRef Hehenkamp WJ, Volkers NA, Broekmans FJ, de Jong FH, Themmen AP, Birnie E, et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod. 2007;22:1996–2005.CrossRef
8.
go back to reference Rashid S, Khaund A, Murray LS, Moss JG, Cooper K, Lyons D, et al. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids. BJOG. 2010;117:985–9.CrossRef Rashid S, Khaund A, Murray LS, Moss JG, Cooper K, Lyons D, et al. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids. BJOG. 2010;117:985–9.CrossRef
9.
go back to reference Pelage JP, Soyer P, Repiquet D, Herbreteau D, Le Dref O, Houdart E, et al. Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology. 1999;212:385–9.CrossRef Pelage JP, Soyer P, Repiquet D, Herbreteau D, Le Dref O, Houdart E, et al. Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology. 1999;212:385–9.CrossRef
10.
go back to reference Vegas G, Illescas T, Muñoz M, Pérez-Piñar A. Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2006;127:68–72.CrossRef Vegas G, Illescas T, Muñoz M, Pérez-Piñar A. Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2006;127:68–72.CrossRef
11.
go back to reference Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D, Grignaffini A. Uterine artery embolization in the treatment and prevention of postpartum hemorrhage. Int J Gynaecol Obstet. 2007;96:181–5.CrossRef Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D, Grignaffini A. Uterine artery embolization in the treatment and prevention of postpartum hemorrhage. Int J Gynaecol Obstet. 2007;96:181–5.CrossRef
12.
go back to reference Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod. 2008;23:1553–9.CrossRef Chauleur C, Fanget C, Tourne G, Levy R, Larchez C, Seffert P. Serious primary post-partum hemorrhage, arterial embolization and future fertility: a retrospective study of 46 cases. Hum Reprod. 2008;23:1553–9.CrossRef
13.
go back to reference Fiori O, Deux JF, Kambale JC, Uzan S, Bougdhene F, Berkane N. Impact of pelvic arterial embolization for intractable postpartum hemorrhage on fertility. Am J Obstet Gynecol. 2009;200(384):e1–e4. Fiori O, Deux JF, Kambale JC, Uzan S, Bougdhene F, Berkane N. Impact of pelvic arterial embolization for intractable postpartum hemorrhage on fertility. Am J Obstet Gynecol. 2009;200(384):e1–e4.
14.
go back to reference Hardeman S, Decroisette E, Marin B, Vincelot A, Aubard Y, Pouquet M, et al. Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases. Fertil Steril. 2010;94:2574–9.CrossRef Hardeman S, Decroisette E, Marin B, Vincelot A, Aubard Y, Pouquet M, et al. Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases. Fertil Steril. 2010;94:2574–9.CrossRef
15.
go back to reference Maeda N, Verret V, Moine L, Bédouet L, Louguet S, Servais E, et al. Targeting and recanalization after embolization with calibrated resorbable microspheres versus hand-cut gelatin sponge particles in a porcine kidney model. J Vasc Interv Radiol. 2013;24:1391–8.CrossRef Maeda N, Verret V, Moine L, Bédouet L, Louguet S, Servais E, et al. Targeting and recanalization after embolization with calibrated resorbable microspheres versus hand-cut gelatin sponge particles in a porcine kidney model. J Vasc Interv Radiol. 2013;24:1391–8.CrossRef
Metadata
Title
Uterine artery embolization for postpartum and postabortion hemorrhage: a retrospective analysis of complications, subsequent fertility and pregnancy outcomes
Authors
Masafumi Toguchi
Yuko Iraha
Junji Ito
Wataru Makino
Kimei Azama
Joichi Heianna
Fumikiyo Ganaha
Yoichi Aoki
Sadayuki Murayama
Publication date
01-03-2020
Publisher
Springer Japan
Published in
Japanese Journal of Radiology / Issue 3/2020
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-019-00907-2

Other articles of this Issue 3/2020

Japanese Journal of Radiology 3/2020 Go to the issue