Capmas P, Picone O, Musset D, Frydman R, Fernandez H
Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), 82 rue du Général-Leclerc, Le-Kremlin-Bicêtre, France.
J Gynecol Obstet Biol Reprod (Paris). 2012 May;41(3):298-306. doi: 10.1016/j.jgyn.2012.01.001. Epub 2012 Mar 20.
Ligation of the internal iliac arteries and embolization of the uterine arteries are two techniques routinely used in the management of postpartum hemorrhage. The objective of this study was to examine the long-term consequences of these techniques on women's subsequent reproductive outcome and subsequent delivery morbidity.
Retrospective study including women who underwent ligation and those who underwent embolization, for the treatment of postpartum hemorrhage. We analyzed resumption of menses, fertility, pregnancy and delivery outcome after each treatment.
The study included 85 women who underwent ligation and 90 who had embolization to treat postpartum hemorrhage. No adverse event related to menses, fertility, or pregnancy outcome followed either treatment. However, the rate of recurrent hemorrhage was high: 26% after ligation and 39% after embolization. All recurrences were treated medically in the ligation group, but in the embolization group, 42% (five of 12 patients) required invasive treatment and 33% (four patients) transfusions.
From the perspective of subsequent menses, fertility and pregnancy outcome, both ligation and embolization are safe procedures for the management of postpartum hemorrhage. However, our results showed a high risk of recurrent postpartum hemorrhage after both treatments. Recurrences seemed more serious after the latter.
髂内动脉结扎术和子宫动脉栓塞术是产后出血管理中常用的两种技术。本研究的目的是探讨这些技术对女性后续生殖结局和分娩并发症的长期影响。
回顾性研究，纳入因产后出血接受结扎术和栓塞术的女性。我们分析了每种治疗后月经恢复情况、生育能力、妊娠及分娩结局。
该研究纳入了85例行结扎术和90例行栓塞术治疗产后出血的女性。两种治疗后均未出现与月经、生育能力或妊娠结局相关的不良事件。然而，复发性出血率较高：结扎术后为26%，栓塞术后为39%。结扎组所有复发性出血均采用药物治疗，但在栓塞组，42%（12例患者中的5例）需要侵入性治疗，33%（4例患者）需要输血。
从后续月经、生育能力和妊娠结局的角度来看，结扎术和栓塞术对于产后出血的管理都是安全的操作。然而，我们的结果显示两种治疗后产后复发性出血的风险都很高。栓塞术后复发性出血似乎更严重。
