Download PDF
Am J Perinatol 2024; 41(S 01): e1257-e1263
DOI: 10.1055/s-0043-1761917
Original Article

Fertility after Transcatheter Arterial Embolization for Obstetric Hemorrhage: An Urban Health Care System Observational Study

Authors

  • Ariana C. Mills 

    1   Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York

  • Brett Marinelli

    2   Biomedical Engineering and Imaging Institute, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
    3   Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York

  • Emma D. Klein

    1   Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York

  • Kirema Garcia-Reyes

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Dan Shilo

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Scott Nowakowski

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Rahul Patel

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Rajesh Patel

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Edward Kim

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Aaron Fischman

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Vivian Bishay

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

  • Holly Loudon

    5   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York

  • Joanne Stone

    5   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York

  • Robert Lookstein

    4   Division of Vascular and Interventional Radiology, Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

Funding None.
Further Information
Also available at
   Permissions and Reprints
Preview

Abstract

Objective This study aimed to investigate pregnancy rate, pregnancy outcomes, and resumption of menses after transcatheter arterial embolization (TAE) for obstetric hemorrhage (OH).

Study Design Sixty-seven patients who underwent TAE for OH from 2006 to 2020 within an urban, multihospital health care system were identified retrospectively. Selected patients were interviewed by phone to complete a survey with a primary outcome of self-reported pregnancy in those seeking pregnancy. Secondary outcomes included pregnancy outcomes and resumption of menses. Univariate testing of association of pregnancy and miscarriage rate with embolic agent was performed using Fisher's exact test.

Results Thirty-three of 50 patients (66%) meeting the inclusion criteria completed the survey on fertility, a median of 47 (range, 13–123) months after TAE for OH. Of the 13 patients who attempted pregnancy, there was a pregnancy rate of 77% and miscarriage rate of 38%. Those who delivered live newborns conceived spontaneously, carried to term, and delivered a healthy newborn via cesarean section at a weight appropriate for gestational age. Thirty (91%) patients resumed menstruation, and the majority with unchanged frequency. Most patients underwent bilateral uterine artery embolization with radial artery access (54%). The most common embolic agents used were gelfoam only (30%) and glue only (24%). There was no statistically significant association between embolic agent and pregnancy or miscarriage rate.

Conclusion Spontaneous pregnancy with live birth and resumption of menses can occur in a majority of patients after TAE for OH.

Key Points

  • Most patients who attempted pregnancy after TAE for OH achieved pregnancy.

  • Most patients who became pregnant conceived spontaneously and delivered healthy newborns at term.

  • Most patients resumed menstruation after TAE for OH.

  • There was no significant association between type of embolic and pregnancy or miscarriage rate.

Keywords

postpartum - obstetric - hemorrhage - embolization - fertility


Publication History

Received: 02 June 2022

Accepted: 24 December 2022

Article published online:
01 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA