Skip to main content

Advertisement

SpringerLink
Log in

Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

To evaluate long-term effects of arterial embolization (AE) for postpartum hemorrhage (PPH) on menses recovery and subsequent pregnancies. One hundred thirteen consecutive patients, recruited from 1999 to 2006, who had undergone AE for severe PPH were evaluated in a retrospective monocentric study. As embolization agents, pledgets of absorbable gelatine sponge (Curaspon®) were used in 106 cases, Curaspon powder in 3 cases, and inert microparticles in 4 cases. In 111/113 cases (98.1%), AE was successful in controlling PPH. In two cases (1.7%), the AE was unsuccessful and required a total abdominal postembolization hysterectomy. Concerning fertility, 6 patients were lost to follow-up and 107 were available. The average time to follow-up was 46.4±21.8 months. Of the 107 patients, 99 had recovery of menses (92.5%). Of the 107 (61%) patients, 66 reported regular menstruation with normal delay after the delivery. Thirty-three patients (31%) reported subjective changes in the frequency and amount of menses. Six patients (5.6%) had documented amenorrhea after AE and developed diffuse uterine synechiae at the hysteroscopic investigation. Out of 29 patients who desired and attempted conception, 18 patients (62%) reported a total of 19 pregnancies at the end of the follow-up. One miscarriage at 12 weeks of gestation was reported. The 18 pregnancies at term were uneventful until delivery, but 3 cases of further PPH (15%) occurred due to abnormal placentation requiring a further AE. All full-term newborns were healthy. AE is a feasible, safe, and reproducible technique to control PPH, allowing a very high resumption of menses and subsequent pregnancies; in these cases, considering the elevated incidence of further PPH due to abnormal placentation, an accurate ultrasonographic monitoring during pregnancy seems appropriate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. King PA, Duthie SJ, Dong ZG, Ma HK (1989) Secondary postpartum haemorrhage. Aust N Z J Obstet Gynaecol 29:394–398

    Article  PubMed  CAS  Google Scholar 

  2. Mousa HA, Walkinshaw S (2001) Major postpartum haemorrhage. Curr Opin Obstet Gynecol 13:595–603

    Article  PubMed  CAS  Google Scholar 

  3. Bonnar J (2000) Massive obstetric haemorrhage. Baillieres Best Pract Res Clin Obstet Gynaecol 14:1–18

    Article  PubMed  CAS  Google Scholar 

  4. As AK, Hagen P, Webb JB (1996) Tranexamic acid in the management of postpartum haemorrhage. Br J Obstet Gynaecol 103:1250–1251

    PubMed  CAS  Google Scholar 

  5. Mitty HA, Sterling KM, Alvarez M, Gendler R (1993) Obstet hemorrhage. Prophylactic and emergency arterial catheterization and embolotherapy. Radiology 188:183–187

    PubMed  CAS  Google Scholar 

  6. Gilbert WM, Moore TR, Resnik R, Doemeny J, Chin H, Bookstein JJ (1992) Angiographic embolization in the management of hemorrhagic complications of pregnancy. Am J Obstet Gynecol 166(2):493–497

    PubMed  CAS  Google Scholar 

  7. Boulleret C, Chahid T, Gallot D, Mofid R, Tran Hai D, Ravel A, Garcier JM, Lemery D, Boyer L (2004) Hypogastric arterial selective and superselective embolization for severe post partum hemorrhage: a retrospective review of 36 cases. Cardio Vasc Intervent Radiol 27:344–348

    CAS  Google Scholar 

  8. Ornan D, White R, Pollak J, Tal M (2003) Pelvic Embolization for intractable postpartum hemorrhage: Long-term follow-up and implications for fertility. Obstet Gynaecol 102:904–910

    Article  Google Scholar 

  9. Salomon LJ, de Tayrac R, Castaigne-Meary V, Audibert F, Musset D, Ciorascu R, Frydman R, Fernandez H (2003) Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. Hum Reprod 18(4):849–852

    Article  PubMed  CAS  Google Scholar 

  10. Descargues G, Mauger Tinlot F, Douvrin F, Clavier E, Lemoine JP, Marpeau L (2004) Menses, fertility and pregnancy after arterial embolization for the control of postpartum haemorrhage. Hum Reprod 19(2):339–343

    Article  PubMed  CAS  Google Scholar 

  11. Stancato-Pasik A, Mitty HA, Richard HM, Eshkar N (1997) Obstetric embolotherapy: Effect on menses and pregnancy. Radiology 204:791–793

    PubMed  CAS  Google Scholar 

  12. Conference on Perioperative Red Blood Cell Transfusion (1988) JAMA 260:2700–2703

    Article  Google Scholar 

  13. Coeuret Pellicier M, Bouvier Colle MH, Salavane Bet le groupe MOMS (1999) Les cases obstétricales de décès expliquent-elles les différences de mortalité maternelle entre la France et l’Europe. J Gynecol Obstet Biol Reprod 28:62–68

    Google Scholar 

  14. Pelage JP, Soyer P, Repiquet D, Herbreteau O, Le Dref O, Houdart E et al (1999) Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology 212:385–389

    PubMed  CAS  Google Scholar 

  15. Brown BJ, Heaston DK, Poulson AM et al (1979) Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet Gynecol 54:361–365

    PubMed  CAS  Google Scholar 

  16. Pelage JP, Le Dref O, Jacob D, Soyer P, Herbreteau D, Rymer R (1999) Selective arterial embolization of the uterine arteries in the management of intractable postpartum hemorrhage. Acta Obstet Gynecol Scan 78:698–703

    Article  CAS  Google Scholar 

  17. Badawy SZ, Etman A, Singh M, Murphy K, Mayelli T, Philadelphia M (2001) Uterine artery embolization: The role in obstetrics and gynecology. Clin Imaging 25:288–295

    Article  PubMed  CAS  Google Scholar 

  18. Vedantham S, Goodwin SC, McLucas B, Mohr G (1997) Uterine artery embolization: an underused method of controlling pelvic hemorrhage. Am J Obstet Gynecol 176:938–948

    Article  PubMed  CAS  Google Scholar 

  19. Eriksson LG, Mulic-Lutvica A, Jangland L, Nyman R (2007) Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle. Acta Radiol 48(6):635–642

    Article  PubMed  Google Scholar 

  20. Hong TM, Tseng HS, Lee RC, Wang JH, Chang CY (2004) Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage. Clin Radiol 59(1):96–101

    Article  PubMed  Google Scholar 

  21. Sergent F, Resch B, Verspyck E, Rachet B, Clavier E, Marpeau L (2004) Intractable postpartum haemorrhages: where is the place of vascular ligations, emergency peripartum hysterectomy or arterial embolization? Gynecol Obstet Fertil 32(4):320–324

    Article  PubMed  CAS  Google Scholar 

  22. Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M, Dahan H, Repiquet D, Payen D, Truc JB, Merland JJ, Rymer R (1998) Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 208(2):359–362

    PubMed  CAS  Google Scholar 

  23. Heaston K, Mineau DE, Brown BJ, Miller FJ (1979) Transcatheter arterial embolization for control of persistent massive puerperal hemorrhage after bilateral surgical hypogastric artery ligation. AJR 133:152–154

    PubMed  CAS  Google Scholar 

  24. Soncini E, Pelicelli A, Larini P, Marcato C, Monaco D, Grignaffini A (2007) Uterine artery embolization in the treatment and prevention of postpartum hemorrhage. Int J Gynaecol Obstet 96(3):181–185 Epub 2007 Feb 6

    Article  PubMed  CAS  Google Scholar 

  25. Vegas G, Illescas T, Muñoz M, Pérez-Piñar A (2006) Selective pelvic arterial embolization in the management of obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol 127(1):68–72 Epub 2005 Oct 17

    Article  PubMed  Google Scholar 

  26. Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, Uzan S, Boudghène F (2001) Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol 177(1):145–149

    PubMed  CAS  Google Scholar 

  27. James AH, Jamison MG, Brancazio LR, Myers ER (2006) Venous thromboembolism during pregnancy and the postpartum period:incidence, risk factors and mortality. Am J Obstet Gynecol 194(5):1311–1315

    Article  PubMed  Google Scholar 

  28. Sieber PR (1994) Bladder necrosis secondary to pelvic artery embolization: case report and literature review. J Urol 151:422

    PubMed  CAS  Google Scholar 

  29. Hare WS, Holland CJ (1983) Paresis following internal iliac artery embolization. Radiology 146:47–51

    PubMed  CAS  Google Scholar 

  30. Céline Pirard MD, Jean Squifflet MD, André Gilles MD, Jacques Donnez MD (2002) Uterine necrosis and sepsis after vascular embolization and surgical ligation in a patient with postpartum hemorrhage. Fertil Steril 78(2):412–413

    Article  PubMed  Google Scholar 

  31. Amato P, Roberts AC (2001) Transient ovarian failure: a complication of uterine artery embolization. Fertil Steril 75(2):438–439

    Article  PubMed  CAS  Google Scholar 

  32. Behnam K, Jarmolowski CR (1982) Vesicovaginal fistula following hypogastric embolization for control of intractable pelvic hemorrhage. J Reprod Med 27(5):304–306

    PubMed  CAS  Google Scholar 

  33. Kline JN, Ryals TJ, Galvin JR, Loftus CM, Hunter JH (1993) Pulmonary embolization and infarction. An iatrogenic complication of transcatheter embolization of a cerebral arteriovenous malformation with polyvinyl alcohol sponge. Chest 103(4):1293–1295

    Article  PubMed  CAS  Google Scholar 

  34. McCarthy P, Kennedy A, Dawson P, Allison D (1991) Pulmonary embolus as a complication of therapeutic peripheral arteriovenous malformation embolization. Br J Radiol 64(758):177–178

    Article  PubMed  CAS  Google Scholar 

  35. Roge P, D’Ercole C, Cravello L, Boubli L, Blanc B (1996) Hysteroscopic management of uterine synechiae: a series of 102 observations. Eur J Obstet Gynecol Reprod Biol 65(2):189–193

    Article  PubMed  CAS  Google Scholar 

  36. McCluggage WG, Ellis PK, McClure N, Walker WJ, Jackson PA, Manek S (2000) Pathologic failures of uterine leiomyomas following uterine artery embolization. Int J Gynecol Pathol 19:342–347

    Article  PubMed  CAS  Google Scholar 

  37. Colgan TJ, Pron G, Mocarski EJ, Bennet JD, Asch MR, Common A (2003) Pathologic features of uteri and leiomyomas following uterine artery embolization for leiomyomas. Am J Surg Pathol 27(2):167–177

    Article  PubMed  Google Scholar 

  38. Cottier JP, Fignon A, Tranquart F, Herbreteau D (2002) Uterine necrosis after arterial embolization for postpartum hemorrhage. Obstet Gynecol 100(5 Pt 2):1074–1077

    Article  PubMed  CAS  Google Scholar 

  39. McLucas B, Goodwin S, Adler L, Rappaport A, Reed R, Perrella R (2001) Pregnancy following uterine fibroid embolization. Int J Gynaecol Obstet 74(1):1–7

    Article  PubMed  CAS  Google Scholar 

  40. Shim JY, Yoon HK, Won HS, Kim SK, Lee PR, Kim A (2006) Angiographic embolization for obstetrical hemorrhage: effectiveness and follow-up outcome of fertility. Acta Obstet Gynecol Scand 85(7):815–820

    Article  PubMed  Google Scholar 

  41. Casele HL, Laifer SA. Successful pregnancy after bilateral hypogastric artery ligation. A case report. J REprod Med 42:306–308

  42. Cordonnier C, Ha-Vien D-E, Depret S, Houfflin-Debarge V, Provost N, Subtil D (2002) Foetal growth restriction in the next pregnancy after uterine artery embolization for postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol 103:183–184

    Article  PubMed  Google Scholar 

  43. Maleux G, Timmerman D, Heye S, Wilms G (2006) Acquired uterine vascular malformation: radiological and clinical outcome after transcatheter embolotherapy. Eur Radiol 16:299–306

    Article  PubMed  Google Scholar 

  44. Abbas FM, Currie JL, Mitchell S et al (1994) Selective vascular embolization in benign gynaecologic condition. J Reprod Med 39:492–496

    PubMed  CAS  Google Scholar 

  45. Sumigama S, Itakura A, Ota T, Okada M, Kotani T, Hayakawa H, Yoshida K, Ishikawa K, Hayashi K, Kurauchi O, Yamada S, Nakamura H, Matsusawa K, Sakakibara K, Ito M, Kawai M, Kikkawa F (2007) Placenta previa increta/percreta in Japan: A retrospective study of ultrasound findings, management and clinical course. J Obstet Gynaecol Res 33(5):606–611

    Article  PubMed  Google Scholar 

  46. Comstock CH, Love JJ Jr, Bronsteen RA et al (2004) Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol 190(4):1135–1140

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. C.H.U. Clermont-Ferrand, Department of Gynaecology and Obstetrics, Polyclinique de l’Hôtel-Dieu, Boulevard Leon Malfreyt, 63058, Clermont-Ferrand cedex 1, France

    G. Gaia, A. Calcagno, D. Gallot, R. Botchorishvili, M. Canis & G. Mage

  2. CHU Clermont-Ferrand, Service de Radiologie B, Clermont-Ferrand, 63003, France

    P. Chabrot, L. Cassagnes & L. Boyer

  3. University Clermont 1, UFR Médecine, Clermont-Ferrand, 63001, France

    P. Chabrot, L. Cassagnes & L. Boyer

  4. Inserm, ERI 14, EA 3295, ERIM, Clermont-Ferrand, 63001, France

    P. Chabrot, L. Cassagnes & L. Boyer

  5. Department Gynaecology and Obstetrics, Polyclinique de l’Hôtel-Dieu CHU, Clermont-Ferrand, France

    G. Gaia

Authors
  1. G. Gaia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Chabrot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Cassagnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Calcagno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Gallot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Botchorishvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Canis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Mage
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Boyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Gaia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gaia, G., Chabrot, P., Cassagnes, L. et al. Menses recovery and fertility after artery embolization for PPH: a single-center retrospective observational study. Eur Radiol 19, 481–487 (2009). https://doi.org/10.1007/s00330-008-1140-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-008-1140-5

Keywords

Search

Navigation