CRD summary

This review concluded that pelvic arterial embolisation offered a safe and conservative alternative to surgical intervention for post-partum haemorrhage in women who desired to preserve future fertility. As this did not appear to be a systematic review and the evidence was from retrospective studies and case reports, these conclusions need to be considered with caution.

Authors' objectives

To study the obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum haemorrhage.

Searching

MEDLINE and Science Direct were searched for papers published in French or English between 1997 and July 2008. Search terms were reported. References of papers were handsearched.

Study selection

Eligible studies recorded intra-uterine pregnancy in women who had been treated with pelvic artery embolisation and who did not respond to routine medical treatment for life-threatening post-partum haemorrhage. Studies where post-partum haemorrhage was managed by hysterectomy or artery ligation before embolisation or that included different treatments such as artery ligation or embolisation and that did not report outcomes separately were excluded. Procedural outcomes of interest were: haemorrhage classification; embolisation material; and clinical success (defined as disparition or persistent small bleeding with haemodynamic stabilisation after the embolisation procedure). Obstetric outcomes of interest were: duration of the attempt to conceive; number of related pregnancies; pregnancy follow-up; delivery; maternal death; and haemorrhage recurrence.

Included studies were retrospective studies or case reports conducted in USA, China or Europe in women aged between 18 and 43 years; in case reports ages ranged from 30 to 35 years. Women were followed up by direct contact, telephone interviews, questionnaires or letters. Fifty-one percent of women had an early haemorrhage, 4% a late one and the rest were unclear; most embolisation materials were gelatin with or without microparticles or coils.

The authors did not state how many reviewers performed study selection.

Assessment of study quality

The authors did not assess study validity.

Data extraction

Data on embolisation procedures and types and number of outcomes were extracted.

The authors did not state how many reviewers performed data extraction.

Methods of synthesis

Results were presented in tables and as a narrative.

Results of the review

Thirteen studies were included (n=168): nine retrospective studies (n=164) and four case reports.

Embolisation was clinically successful in 154 (92%) of 168 women. Following embolisation, seven (4%) hysterectomies were performed and four (2%) women died. Forty-five pregnancies were recorded and the interval between embolisation and conception ranged from one to 36 months. Of these pregnancies, 32 (71%) resulted in a live birth, eight (18%) were miscarriages and five (11%) patients had a voluntary termination. Of the live births, 10 (38%) were vaginal deliveries, 16 (62%) were caesarean sections and six did not report the method of delivery; two births (6%) were preterm and two (6%) babies had growth retardation. Six women (19%) experienced a recurrent episode of post-partum haemorrhage; two led to hysterectomy.

Authors' conclusions

Pelvic arterial embolisation offers a safe and conservative alternative to surgical intervention for post-partum haemorrhage in well-selected patients who desire to preserve future fertility.

CRD commentary

It was unclear whether this review was a systematic review as there was no reporting of use of systematic review methods and the authors refered to it as a literature review. However, the aims were clearly stated and inclusion criteria for participants, interventions and outcomes were stated. Only two databases were searched and studies restricted to those published in English and French, so it was likely that some relevant reports were missed. Relevant results were summarised descriptively without calculation of effect sizes. As most of the available evidence came from retrospective studies or case series and not prospective randomised trials, the authors conclusions should be considered with caution.

Implications of the review for practice and research

Practice: The authors stated that centres that performed embolisation should provide careful follow-up and counselling for couples during and after the procedure to limit secondary psychological side effects. Pregnancies that occurred after the procedure should be followed in specialist centres to allow early detection of growth retardation and access to specialist expertise if haemorrhage recurred.

Research: The authors did not state any recommendations for practice.

Funding

Not stated.

Bibliographic details

Delotte J, Novellas S, Koh C, Bongain A, Chevallier P. Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage. European Journal of Obstetrics and Gynecology and Reproductive Biology 2009; 145(2): 129-132. [PubMed: 19398259]

Original Paper URL

http://dx.doi.org/10.1016/j.ejogrb.2009.03.013

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Adult; Embolization, Therapeutic; Female; Humans; Hysterectomy; Pelvis /blood supply; Postpartum Hemorrhage /mortality /therapy; Pregnancy; Pregnancy Outcome; Prognosis

AccessionNumber

12009107347

Database entry date

04/08/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.