1. Uterine artery embolization for PPH
Prof David Baud, MD PhD
Switzerland
Uterine artery embolization for PPH

8. Maternal death

9. Prevention Be aware of risk factors Treat anaemia antenatally
Active management of the 3rd stage
Prophylactic oxytocics = reduce risk of PPH by 60% (oxytocin or ergometrine)
Causes: 4T
Tone 70%
Trauma 20%
Tissue 10%
Thrombin 1%

10. Medical
Surgical /
invasive

11. B-Lynch / Ut. Art. ligation
Uterine artery embolisation
Gelatin sponge, Gelfoam, alcohol particles, microparticles

14. Short term complications after UAE for PPH

15. Vascular injuries
1-2%

16. Other complications Vascular injuries Endometritis Distant necrosis
Limb
Intestine
Buttock
Fistula
Ovaries => failure?
Uterine necrosis

17. Uterine necrosis

18. Long term complications after UAE for PPH

19. Return to normal in 81% of patients
Menstrual cycle
Return to normal in 81% of patients

20. Pregnancies after UAE 38 studies with long F/U = 1072 patients
23% had subsequent pregnancies
Among 499 patients who were asked whether they were attempting pregnancy, 35% answer YES % were able to conceive delay to conceive = 4-12 months uterine synechiae as cause of infertility Normal birth weight more placenta accreta (20%) % recurence PPH

21. Our own study

22. Method Retrospective study
All patients treated with embolization for PPH
2003 – 2013
Outcomes:
Gynaecological symptoms
Future fertility
Obstetrical outcomes
Psychological impact

23. Inclusion

24. Matching 1:3 Maternal age Ethnicity Year of delivery Parity
Mode of delivery
Birth weight
Gestational age

25. MORE TIME TO GET PREGNANT

26. NO MAJOR DIFFERENCE IN GYNECOLOGICAL & SEXUAL OUTCOME

27. NO ADVERSE PREGNANCY OUTCOMES EXCEPT MORE CESAREAN & PPH

28. Conclusion After embolization for PPH: SIMILAR menstrual cycle
SIMILAR sexual function
SIMILAR fertility, but...
Subsequent pregnancies:
Time to achieve a new pregnancy is longer after UAE
Fear to get pregnant might be a major factor
SIMILAR obstetrical complications, except for recurrence of PPH and cesaerian

29. Mini-International Neuropsychiatric Interview1
Have you ever been consistently depressed or down, most of the day, nearly every day? 2
Have you been much less interested in most things or much less able to enjoy the things you used to enjoy most of the time? 3
After the birth of the baby have you been much less interested in most things? 4
Was your appetite decreased or increased nearly every day? If unclear, did your weight decrease or increase without trying intentionally? 5
Did you have trouble sleeping nearly every night (difficulty falling asleep, waking up in the middle of the night, waking early in the morning) or sleeping excessively? 6
Did you talk or move more slowly than normal or were you fidgety, restless or having trouble sitting still almost every day? 7
Did you feel tired or without energy almost every day? 8
Did you feel worthless? 9
Did you feel guilty? 10
Did you have difficulty concentrating or making decisions?

30. MINI - maternal

31. Post-traumatic stress disorder
Walters JT, Bisson JI, Shepherd JP. Predicting post-traumatic stress disorder: validation of the Trauma Screening Questionnaire in victims of assault. Psychol Med Jan;37(1): Epub 2006 Sep 7

32. TSQ maternal

33. TSQ Paternal ? ?

34. MINI Paternal

35. TSQ Paternal

36. Conclusions Preserved fertility after embolization
Good pregnancy outcomes after embolization, except recurrent PPH & CS!!
Do not underestimate Post-Traumatic Stress !!!
Also partner

37. THANKS
Francoise Damnon Karine Lepigeon Dominique Bertaud Mathilde Morisod Maude Bernasconi