Poggi Sarah H, Yaeger Andrew, Wahdan Yesmean, Ghidini Alessandro
The Brock Family Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA; School of Medicine, George Washington University Hospital, Washington, DC.
School of Medicine, George Washington University Hospital, Washington, DC.
Am J Obstet Gynecol. 2015 Oct;213(4):576.e1-5. doi: 10.1016/j.ajog.2015.06.063. Epub 2015 Jul 8.
The effects of pelvic artery embolization (PAE) for postpartum hemorrhage (PPH) on subsequent pregnancies have been explored in small case series and one case-control study by mailed questionnaire with uncomplicated pregnancies as controls. We conducted a single-center retrospective cohort study using women with PPH without PAE for comparison.
From a cohort of 103 women undergoing PAE for primary PPH between January 1999 and December 2012 (exposed) and 189 pregnancies with PPH not requiring PAE between January 2008 and December 2012 (unexposed), we queried the electronic medical records for readmissions to labor and delivery in subsequent years. Outcomes of subsequent pregnancies continuing past 20 weeks were obtained by chart review.
Repeat pregnancies were documented in 17 of 103 exposed women (16.5%) and 18 of 189 unexposed women (9.5%). At delivery complicated by PPH, the groups did not differ in demographics, gestational age, units of blood transfused, or PPH cause. At the time of subsequent deliveries, there was a greater interdelivery interval in women exposed to PAE than those unexposed (1710 ± 938 days vs 904 ± 358 days; P = .002), and the 2 groups were similar in terms of gestational age and birthweight. However, there was a significantly higher rate of placenta accreta in exposed than unexposed women (23.5 % vs 0%; P = .04), with 3 of 17 sustaining total abdominal hysterectomy and 1 requiring repeat PAE for severe PPH.
Pregnancies following PAE for PPH were more likely than those not receiving PAE for treatment to be complicated by placenta accreta. Pregnancies following PAE should be followed up for imaging evidence of placenta accreta.
在小型病例系列研究以及一项通过邮寄问卷进行的病例对照研究中，以未出现并发症的妊娠作为对照，探讨了盆腔动脉栓塞术（PAE）治疗产后出血（PPH）对后续妊娠的影响。我们开展了一项单中心回顾性队列研究，以未接受PAE治疗的PPH女性作为对照。
从1999年1月至2012年12月期间接受PAE治疗原发性PPH的103名女性队列（暴露组）以及2008年1月至2012年12月期间189例不需要PAE治疗的PPH妊娠（非暴露组）中，我们查询了后续年份再次入院分娩的电子病历。通过病历审查获得后续持续超过20周妊娠的结局。
103名暴露组女性中有17名（16.5%）记录有再次妊娠，189名非暴露组女性中有18名（9.5%）记录有再次妊娠。在因PPH导致的分娩并发症方面，两组在人口统计学、孕周、输血单位或PPH病因上无差异。在后续分娩时，暴露于PAE的女性分娩间隔时间比未暴露女性更长（1710±938天 vs 904±358天；P = 0.002），两组在孕周和出生体重方面相似。然而，暴露组胎盘植入的发生率显著高于非暴露组（23.5% vs 0%；P = 0.04），17名暴露组女性中有3名接受了全腹子宫切除术，1名因严重PPH需要再次进行PAE治疗。
与未接受PAE治疗的妊娠相比，PAE治疗PPH后的妊娠更易并发胎盘植入。PAE治疗后的妊娠应进行随访，以获取胎盘植入的影像学证据。
