Efficacy of transarterial embolisation in the management of post-partum haemorrhage and its impact on subsequent pregnancies.

Abstract

Transarterial embolisation (TAE) has been attracting attention as a treatment option for post-partum haemorrhage (PPH). We investigated cases in which TAE was performed for PPH to determine the efficacy of TAE for the treatment of PPH and its impact on subsequent pregnancies and childbirth in a multi-institutional case-series study. A total of 211 women who underwent emergency (n=161) or prophylactic (n=50) TAE for the management of PPH from 2002 to 2011 in the Chugoku and Shikoku regions of Japan were evaluated. Data on maternal background, treatment efficacy, adverse events in 113 cases followed up after TAE and subsequent pregnancies in 76 women were obtained. The overall success rate of emergency and prophylactic TAE was 91.9 and 96.0%, respectively. The rate of complications such as infection, uterine necrosis and amenorrhoea was 13.3% among women followed up after TAE. Forty women became pregnant after TAE, and the pregnancy rate among those who desired fertility was 52.6%. Twenty-eight gave birth, including four preterm deliveries. Five (16.7%) were associated with a hysterectomy due to placenta accreta. To reduce haemorrhage and avoid hysterectomy, TAE may be considered as a treatment option for PPH, however short and long terms complications are not uncommon.