Risk of infertility following pelvic angiographic embolization in female patients with pelvic fractures: A nationwide population-based cohort study in Taiwan.

Sheng-Der Hsu,Chi-Hsiang Chung,Chun-Shu Lin,Shih-Yu Lee,Wu-Chien Chien,Wei-Kuo Chang,Cheng-Jueng Chen,Kuen-Tze Lin,Stanislaw Stepkowski

doi:10.1371/journal.pone.0174733

Sheng-Der Hsu, Chi-Hsiang Chung + Show 7 more

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https://doi.org/10.1371/journal.pone.0174733

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Abstract

Pelvic angiographic embolization is an effective procedure to provide haemostasis in patients with pelvic fractures. However, management with repeated follow-up radiographs may result in infertility. The study aimed to evaluate the risk of infertility following pelvic fracture treated with pelvic angiographic embolization in female patients. We used data from the National Health Insurance Research Database (NHIRD) provided by the Bureau of National Health Insurance of the Department of Health in Taiwan from the period of 1997–2010. A total of 36 and 18,029 patients were included in the case and control cohorts, respectively. The risk estimations for the case and control cohorts were compared using a Cox’s proportional hazards regression model. The significance level was set at <0.05. After adjusting for possible confounding factors, the incidence of infertility in the case cohort was nearly 30.7-fold higher than that in the control cohort (adjust hazard ratio [HR] = 30.7, 95% confidence interval [CI] = 10.643–70.109). Patients between 15–35 years of age had a much higher incidence of infertility in the case cohort than in the control cohort (adjusted HR = 49.9, 95% CI = 15.177–64.099). Taken together, pelvic fractures in female patients treated with arterioembolization for haemostasis might be associated with a higher risk of infertility in Taiwan. Physicians should be aware of the link and inform patients of this risk prior to arterioembolization.

Highlights

Proportion of patients with inflammatory disease of the ovary, fallopian tube, pelvic cellular tissue, peritoneum, or with endometriosis was higher in the case cohort than in the control cohort (p < 0.001)
Eight of 36 patients in the case cohort had a diagnosis of diabetes mellitus versus 561 of 18,029 patients in the control cohort (p < 0.001)
The proportion of patients receiving blood transfusion was higher in the case cohort than in the control cohort (p < 0.001; Table 1)

Summary

Introduction

Among patients with multiple blunt traumatic injuries, 5%–16% sustain trauma to the pelvic ring, resulting in a mortality rate of 11%–54%, primarily due to haemorrhagic shock [1,2,3]. Risk of infertility following pelvic angiographic embolisation in female patients. Embolization is commonly used to control arterial bleeding after pelvic trauma. Many researchers have evaluated the relationship between PAE for postpartum haemorrhage and fertility. They concluded that embolization is a safe and effective nonsurgical method that does not alter subsequent fertility [8,9]. We hypothesized that, due to radiation exposure, infertility may be increased in female patients with pelvic fracture treated with PAE. We performed a large-scale nationwide retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) to evaluate the risk of infertility following PAE in female pelvic fracture patients

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