Fertility after uterine artery embolization for postpartum hemorrhage

Abstract

No. 332 Fertility after uterine artery embolization for postpartum hemorrhage D.R. Kirtland, M.L. Censullo; Department of Radiology, UMDNJ, Robert Wood Johnson University Hospita, New Brunswick, NJ Purpose: Uterine artery embolization (UAE) and hysterectomy are both used to manage postpartum hemorrhage. The outcomes of postpartum hemorrhage UAE on future fertility have been variably mentioned in prior reports, but a dedicated study has not yet been reported to evaluate fertility after UAE for treatment of postpartum hemorrhage. Materials and Methods: A search of the PUBMED database was performed from January 1995 to September 2011. The keyword search included the terms: uterine artery embolization and postpartum hemorrhage. The inclusion of studies was based on the reporting of relevant data: total patients, patients desiring fertility, resulting pregnancies, and births. Results: Our analysis includes 10 studies with 420 total patients treated for postpartum hemorrhage with UAE. Not all patients avoided eventual hysterectomy, but of those that did, 112 desired another pregnancy. 111 total pregnancies and 92 live births resulted. Several studies did not distinguish the exact number of pregnancies or births per patient, and as a result this analysis simply examines the total number of pregnancies and births. Assuming 1 pregnancy or birth per patient, 99% of the patients were able to become pregnant, and 82% of those pregnancies achieved a live birth. A chi square analysis shows statistical significance (p 0.027). Conclusion: Fertility preservation is a strong motivation for choosing UAE over hysterectomy for postpartum hemorrhage. These results demonstrate fertility is successfully preserved in many patients. It does not escape the authors’ attention that fertility outcomes are superior to hysterectomy. Postpartum Hemorrhage Treated With UAE Desired Pregnancy Post UAE Pregnancies Post UAE Live Birthes Post UAE Boyer et al. 2006 36 3 3 2 Chauler et al. 2008 41 16 17 16 Descargues et al. 2004 25 11 10 6 Eriksson et al. 2007 20 7 7 7 Gaia et al. 2008 111 29 19 18 Hardman et al. 2009 53 14 14 11 Ornan et al. 2003 27 6 6 6 Salomon et al. 2003 277 6 5 4 Sentilhes et al. 2009 68 17 26 19 Stancato-Pasik et al. 1997 12 3 4 3 Totals 420 112 111 92 Educational Exhibit Abstract No. 333 Ovarian artery embolization in uterine fibroids: a pictorial review R. Kodur, F. Aris, E. Moon, G. McLennan; interventional radiology, cleveland clinic, cleveland, OH Learning Objectives: In this pictorial review we will discuss the indications, procedural technique and complications of ovarian artery embolization in the treatment of uterine fibroids. Background: Ovarian artery embolization is a well established adjunct procedure in treatment of selected patients with uterine fibroids, where the fibroids derive their blood supply from the ovarian arteries. We present our experience in a large tertiary hospital. Clinical Findings/Procedure Details: Prior to performing ovarian/uterine artery embolization patients are assessed for contraindications. Risk of early ovarian failure and menopause associated with ovarian artery embolization is explained to the patients. Access is obtained into the right femoral artery. A 5F Cobra catheter is used to cannulate the contralateral uterine artery followed by selective cannulation of the horizontal portion of the left uterine artery using a micro catheter. A preliminary angiogram is performed to look for cervical, vaginal or vesical branches. Embolization is performed with 500 –700 micron embospheres reconstituted with 10 cc of ultravist 300 contrast per vial. The procedure is repeated on the right after cannulating the right uterine artery. Routine aortogram to look for prominent ovarian arteries and blush of the uterine fibroids is performed. If one is found, selective cannulation is performed using a combination of SOS catheter and a micro catheter. The micro catheter is advanced the end of the straight vertical portion to prevent reflux of the embolic material into the aorta. A check angiogram is performed to look for any blush of the uterine fibroids. If one is found embolization is performed with 500–700 embozenes to slow flow. After the procedure, the patient is admitted overnight with a narcotic based patient controlled analgesia for pain relief and monitoring of hemodynamic status.Patient is discharged the day following the procedure and a follow-up gynecology appointment is arranged in four weeks after embolization. Conclusion and/or Teaching Points: Ovarian artery embolization as an adjunct to uterine artery embolization in the treatment of uterine fibroids can reduce the incidence of clinical treatment failure, particularly when the fibroids have a ovarian artery supply.