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Uterine artery embolization for PPH

Prof David Baud, MD PhD Switzerland. Uterine artery embolization for PPH. Maternal death. Prevention. Be aware of risk factors Treat anaemia antenatally Active management of the 3 rd stage Prophylactic oxytocics = reduce risk of PPH by 60% ( oxytocin or ergometrine ) Causes: 4T

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Uterine artery embolization for PPH

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  1. Prof David Baud, MD PhD Switzerland Uterineartery embolization for PPH

  2. Maternal death

  3. Prevention • Be aware of risk factors • Treat anaemia antenatally • Active management of the 3rd stage • Prophylactic oxytocics = reduce risk of PPH by 60% (oxytocin or ergometrine) • Causes: 4T • Tone 70% • Trauma 20% • Tissue 10% • Thrombin 1%

  4. Medical Surgical / invasive

  5. B-Lynch /Ut. Art. ligation Uterine arteryembolisation Gelatinsponge, Gelfoam, alcoholparticles, microparticles

  6. Short termcomplicationsafter UAE for PPH

  7. Vascular injuries 1-2%

  8. Other complications • Vascular injuries • Endometritis • Distant necrosis • Limb • Intestine • Buttock • Fistula • Ovaries => failure? • Uterinenecrosis

  9. Uterinenecrosis

  10. Long termcomplicationsafter UAE for PPH

  11. Menstrual cycle • Return to normal in 81% of patients

  12. Pregnancies after UAE • 38 studies with long F/U = 1072 patients • 23% had subsequent pregnancies • Among 499 patients who were asked whether they were attempting pregnancy, 35% answer YES- 76% were able to conceive - delay to conceive = 4-12 months - uterine synechiae as cause of infertility - Normal birth weight - more placenta accreta (20%) - 20% recurence PPH

  13. Our ownstudy

  14. Method • Retrospective study • All patients treated with embolization for PPH • 2003 – 2013 • Outcomes: • Gynaecological symptoms • Future fertility • Obstetrical outcomes • Psychological impact

  15. Inclusion

  16. Matching 1:3 Maternal age Ethnicity Year of delivery Parity Mode of delivery Birth weight Gestational age

  17. MORE TIME TO GET PREGNANT

  18. NO MAJOR DIFFERENCE IN GYNECOLOGICAL & SEXUAL OUTCOME

  19. NO ADVERSE PREGNANCY OUTCOMES EXCEPT MORE CESAREAN & PPH

  20. Conclusion After embolization for PPH: SIMILAR menstrual cycle SIMILARsexual function SIMILARfertility, but... Subsequent pregnancies: Time to achieve a new pregnancy is longer after UAE Fear to get pregnant might be a major factor SIMILARobstetrical complications, except for recurrence of PPH and cesaerian

  21. Mini-International Neuropsychiatric Interview

  22. MINI - maternal

  23. Post-traumatic stress disorder Walters JT, Bisson JI, Shepherd JP. Predicting post-traumatic stress disorder: validation of the Trauma Screening Questionnaire in victims of assault. Psychol Med. 2007 Jan;37(1):143-50. Epub 2006 Sep 7

  24. TSQ maternal

  25. TSQ Paternal ? ?

  26. MINI Paternal

  27. TSQ Paternal

  28. Conclusions • Preserved fertility after embolization • Good pregnancy outcomes after embolization, except recurrent PPH & CS!! • Do not underestimate Post-Traumatic Stress !!! • Also partner

  29. THANKS Francoise Damnon KarineLepigeon Dominique Bertaud MathildeMorisod Maude Bernasconi

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