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Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review

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

Abstract

Objectives

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.

Conclusion

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.

Key Points

• 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

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Abbreviations

AE:

Arterial embolisation

CS:

Caesarean section

PA:

Placenta accreta

PPH:

Postpartum haemorrhage

SIADH:

Syndrome of inappropriate antidiuretic hormone secretion

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Acknowledgments

We warmly thank Kirsten Niles, Karine Lepigeon, Robin Avona Hampton and Sam Vasilevsky for critical review of the manuscript. David Baud was supported by the Swiss National Science Foundation (SNSF) grant number 310030_156169/1, Fondation Leenaards through the Bourse pour la relève académique, by the Fondation Divesa and by the Loterie Romande.

The scientific guarantor of this publication is David Baud. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. No complex statistical methods were necessary for this paper. Institutional review board approval was not required because this is a review.

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Authors and Affiliations

  1. Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland

    Marie-Aimée Päivi Soro, Maud de Rham & David Baud

  2. Department of Radiology, University Hospital, 1011, Lausanne, Switzerland

    Marie-Aimée Päivi Soro & Alban Denys

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  1. Marie-Aimée Päivi Soro
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Correspondence to David Baud.

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Soro, MA., Denys, A., de Rham, M. et al. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol 27, 749–762 (2017). https://doi.org/10.1007/s00330-016-4395-2

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