| Research background:Postpartum hemorrhage(PPH)is the leading cause of maternal perinatal morbidity and mortality worldwide.At present,uterine arterial embolization(UAE),which spares the uterus,has become the first-line therapy for severe postpartum hemorrhage when the conservative therapy is fail and is superior to surgical intervention.Currently,the complication and failure rate of UAE have decreased,the success rate of UAE for PPH is reperted to be 95%,with an 8.7% complication rate [1].However,the complications of UAE can not be ignored,such as premature ovarian failure,amenorrhea,uterine ischemic damage,uterine infection,especially the long-term effects on fertility and obstetric outcomes needs to be studied in a large clinical trial.In recent years,with the adjustment of China's fertility policy,some patients who had previously undergone UAE desire fertility.However,there are few studies about the outcome of pregnancy after UAE treatment at present.Therefore,it is a concern of patients and obstetricians whether UAE will increase an adverse subsequent pregnancy and obstetric outcomes.This study aims to explore the clinical outcome and complications of subsequent pregnancy women with a history of UAE for PPH,aIlalysis the risk factors to intervene and provide theoretical basis and clinical guidance for patients with fertility requirements.Materials and Methods:Source of materials:Selected cases of postpartum hemorrhage from January 2010 to January 2016 in the obstetrics department of Ningbo Women and Children's Hospital,The patients were divided into two groups: uterine artery embolization group(embolization group)and not treated with uterine artery embolization group(control group).Inclusion criteria: The embolization group: 1)postpartum hemorrhage;2)uterine artery embolization successfully spared uterus;The control group : 1)postpartum hemorrhage;2)not treated with uterine artery embolization,use other kind of conservative treatment for postpartum hemorrhage successfully spared uterus,for example uterine cavity tamponade;Exclusion criteria :1)gestational age <20 weeks 4)maternal age> 40 years old 5)severe internal and surgical complications affecting fertility.Methods:Follow up the subsequent pregnancy occurred in the 2 groups,the two cohorts were compared for clinical factors at the previous pregnancy,including clinical factors at the previous pregnancy,including route of delivery,complications of the pregnancy,and causes of PPH.The two groups were well matched in terms of main clinical factors.The clinical data of the subsequent deliveries of two groups were followed up and the database was established.The two cohorts were also compared with subsequent delivery factors including interdelivery interval,gestational age at delivery,birthweight,route of delivery,recurrence of PPH,and cause of PPH(including placenta previa,placenta accrete,uterine atony and DIC),complications such as preeclampsia,diabetes,etc.Case data collection is based on the data of Ningbo Women and Children's Hospital's electronic medical records system and Ningbo maternal and child's health care system and telephone follow-up.If none of the above methods can obtain the subsequent deliveries,the case is abandoned.Results:1?The two groups were followed up for 37 to 109 months,118 cases had been exposed to pregnancy.There were 118 cases of repregnancy in the embolization group,including 15 cases of delivery,12 cases of early termination,9 cases of cesarean scar pregnancy and 4 cases of miscarriages.In the control group,we identified 77 pregnancies,including 17 cases of delivery,18 cases of early termination and 6 cases of cesarean scar pregnancy.2?Comparison of the follow-up of previous pregnancy factors between the two groups:The rates of pregnancy coexisted diseases,complication of delivery was similar between the two groups.There were statistically significant difference in cesarean section rate and placenta previa between the two groups(P<0.001,P=0.023,P<0.05),while the cesarean section rate in the control group was higher than that in the observation group.Atony and placenta previa was the main cause of postpartum hemorrhage in embolization group and control group.3?Comparison of the subsequent pregnancy condition between the two groups:There was no statistically significant difference in the incidence of deliver and spontaneous abortion between the two groups.There was a statistically significant difference in the incidence of early pregnancy abortion between the two groups(P = 0.002).There was a statistically significant difference in the incidence of cesarean scar pregnancy(CSP)between the two groups(X2 = 6.656,P = 0.001 < 0.05),compared with the control group,the odds ratio(OR)was 4.841.The risk of CSP in the embolization group was 4.841 times higher than that in the control group.4?Comparison of subsequent deliveries factors between the two groups:There was no statistically significant difference in pregnancy interval,route of delivery,,gestation week,fetal weight,complications such as diabetes between the two groups,The incidence of postpartum hemorrhage rate?placental accretion and hysterectomy rate was statistically significantly different(P = 0.033,P = 0.047,P=0.013,P < 0.05).Compared with the control group,the OR value of recurrent postpartum hemorrhage in the embolization group was 7.0.The risk of postpartum hemorrhage in the embolization group was 7 times higher than that in the control group.It is thought that UAE increased the risk of placental accretion and associated PPH and hysterectomy during the subsequent delivery.Conclusions1?The risk of CSP in subsequent pregnancies of women receiving UAE was higher than that of women not receiving UAE for PPH.2?The risk of placental accretion and associated recurrence of PPH and hysterectomy with women in subsequent pregnancies receiving UAE was increased in women not receiving UAE for PPH.3?Compared with women not receiving UAE for PPH,the incidence of interdelivery interval,gestational age at delivery,birthweight in subsequent pregnancies with women receiving UAE showed no obvious difference. |
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