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Master Thesis

Pelvic Artery Embolization for Delivery Hemorrhage, assessment of Risk Factors for Severe Maternal Morbidity: A retrospective study

Abstract : Background: Development of pelvic artery embolization, introduced in 1979, has revolutionized the prognosis of postpartum hemorrhage. This technique has the major advantage of preserving fertility and avoiding the need for surgical treatment. It has proven to be effective for postpartum hemorrhage refractory to medical treatment. However, the severe maternal morbidity of this pathology is poorly studied. Objective: The objective of our study is to evaluate the risk factors of severe maternal morbidity in pelvic artery embolization of obstetrical indication. Study Design: We conducted a retrospective study in the two obstetrics departments of Marseille University Hospital between 2013 and 2021. All women who underwent embolization after delivery were included in these two centers during this period. The primary outcome was severe maternal morbidity, defined as a composite outcome: failure of the embolization procedure, and/or major resuscitative complications (admission to intensive care unit and/or transfusion ≥ 5 RBCUs, hemorrhagic shock, disseminated intravascular coagulation) and/or ischemic complications. Univariate and multivariate analyses were performed. Results: Among 2158 patients treated for postpartum hemorrhage and 128 patients managed for placenta accreta in Marseille University Hospitals, 190 patients required an embolization following their delivery. Among these patients, 154 had undergone embolization for refractory hemorrhage, and 36 had undergone prophylactic embolization for placenta accreta. Effectiveness of the procedure in patients with refractory hemorrhage was 94.1% (145/154) and severe maternal morbidity was found in 37.6% (58/154). Risk factors associated with the occurrence of severe maternal morbidity in this group were use of another embolization product than gelatin (OR 4.36 (1.01-18.84) p=0.048) and PPH severity (OR 2.81 (1.21-6.55) p=0.002). The severe morbidity rate for prophylactic PAE in placental disorders was 27.8% (10/36). Our study could not identify any risk factors in this subgroup. Conclusion: Pelvic artery embolization is an effective technique in the management of refractory postpartum hemorrhage with a low major complication rate. Nevertheless, this pathology presents a high severe morbidity (37.6%, 58/154), whose risk factors could be the severity of hemorrhage and the use of another product than gelatin. This study therefore concludes that pelvic artery embolization presents a real benefit in the management of refractory hemorrhage. The risks of ischemic complications are low and should not limit its use. The choice and use of products must be considered, guided by the clinical context.
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https://dumas.ccsd.cnrs.fr/dumas-03403344
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Submitted on : Tuesday, October 26, 2021 - 10:15:04 AM
Last modification on : Tuesday, November 16, 2021 - 3:36:21 AM

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Ornella Maltese. Pelvic Artery Embolization for Delivery Hemorrhage, assessment of Risk Factors for Severe Maternal Morbidity: A retrospective study. Life Sciences [q-bio]. 2021. ⟨dumas-03403344⟩

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