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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (5): 540-545    DOI: 10.3785/j.issn.1008-9292.2019.10.12
    
Outcome of re-pregnancy in women with uterine artery embolization for postpartum hemorrhage
LIN Xiaoxiao1(),SUN Daifei1,FU Jun2,ZHONG Huizhen2,*()
1. Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315012, Zhejiang Province, China
2. Department of Gynecology, Ningbo Women and Children's Hospital, Ningbo 315012, Zhejiang Province, China
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Abstract  

Objective: To evaluate the outcome of re-pregnancy in women with uterine artery embolization(UAE)for postpartum hemorrhage(PPH). Methods: Clinical data of 117 pregnant women with previous PPH admitted in Ningbo Women and Children's Hospital from January 2010 to January 2016 were retrospectively analyzed. Among them 40 cases were treated with UAE (UAE group) and 77 cases were not treated with UAE (control group). The outcomes of re-pregnancy were followed up and compared between two groups. Results: There were significant differences in the incidence of induced abortion in early pregnancy and cesarean scars pregnancy (CSP) between the two groups (P < 0.05 or P < 0.01). In the UAE group, the incidence of PPH, placental accretion and hysterectomy rate was significantly higher than that of control group (P < 0.05 or P < 0.01). Multivariate analysis showed that UAE was independent risk factor for CSP, placenta accretion, PPH and hystere-ctomy (P < 0.05 or P < 0.01). Conclusions: The overall fertility and re-pregnant outcomes in women with previous UAE for PPH are favorable. However, the risk of CSP, placenta accretion and associated recurrence of PPH and hysterectomy is higher in women receiving UAE during subsequent pregnancy.



Key wordsPostpartum hemorrhage/therapy      Arteries      Embolization, therapeutic      Uterus/ blood supply      Pregnancy outcome     
Received: 04 April 2019      Published: 04 January 2020
CLC:  R714.7  
Corresponding Authors: ZHONG Huizhen     E-mail: xiaoxiao4_4@qq.com;nbfeyyzhz@163.com
Cite this article:

LIN Xiaoxiao,SUN Daifei,FU Jun,ZHONG Huizhen. Outcome of re-pregnancy in women with uterine artery embolization for postpartum hemorrhage. J Zhejiang Univ (Med Sci), 2019, 48(5): 540-545.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.10.12     OR     http://www.zjujournals.com/med/Y2019/V48/I5/540


子宫动脉栓塞术治疗产后出血对再次妊娠结局的影响

目的: 探讨子宫动脉栓塞术(UAE)治疗产后出血对再次妊娠结局的影响。方法: 收集宁波市妇女儿童医院产科2010年1月至2016年1月收治的产后出血病例,选取再次妊娠的117例患者病例资料,根据之前是否行UAE治疗分为UAE组(40例)和对照组(未行UAE治疗,77例),比较两组再次妊娠和分娩情况并分析UAE治疗对再次妊娠和分娩的影响。结果: UAE组与对照组早孕人工流产和剖宫产瘢痕妊娠的发生率差异有统计学意义(P < 0.05或P < 0.01),再次妊娠分娩时UAE组子宫切除、复发产后出血、胎盘植入的比例高于对照组(P < 0.01或P < 0.05)。多因素回归分析结果显示,UAE后再次妊娠的患者发生剖宫产瘢痕妊娠的风险增加(P < 0.05),发生胎盘植入及复发产后出血甚至子宫切除的风险增加(P < 0.05或P < 0.01)。结论: UAE后再妊娠产妇发生剖宫产瘢痕妊娠、胎盘植入及相关的产后出血甚至子宫切除的风险增大。


关键词: 产后出血/治疗,  动脉,  栓塞, 治疗性,  子宫/血液供给,  妊娠结局 
Fig 1 Follow up of the second pregnancy of the patients with postpartum hemorrhage
组别n年龄(岁)分娩孕周孕次产次剖宫产出血量(mL)出血原因两次妊娠间隔(月)
前置胎盘子宫收缩乏力胎盘植入凝血功能障碍*
“—”:无相关数据;*确切概率法.UAE:子宫动脉栓塞术.
UAE组4028.6±5.637.0(35.4, 39.0)3.0(2.0, 4, 0)0.0(0.0, 1.0)31(75.6)1700(1200, 2087)7(17.1)23(56.1)11(26.8)0(0.0)36(24, 55)
对照组7728.4±4.436.3(35.1, 38.7)3.0(2.0, 4.0)0.0(0.0, 1.0)77(100.0)1000(800, 1200)31(40.3)32(41.6)12(15.6)2(2.6)32(22, 44)
t/Z/χ20.260-0.741-0.184-0.46617.495-5.4166.5882.2732.156-1.929
P>0.05>0.05>0.05>0.05<0.01<0.01<0.05>0.05>0.05>0.050.054
Tab 1 Previous pregnancy and postpartum hemorrhage in 117 patients with subsequent pregnancy [${\bar x}$±sM(Q1, Q3)或n(%)]
组别n早孕人
工流产
剖宫产瘢
痕妊娠
妊娠分娩自然流产
“—”:无相关数据;*确切概率法.UAE:子宫动脉栓塞术.
UAE组4010(24.4)9/31(29.0)15(36.6)4(9.8)
对照组7744(57.1)6/77(7.8)20(26.0)4(5.2)
t/Z/χ211.5636.6561.4440.307
P<0.01<0.05>0.05>0.05
Tab 2 Clinical outcomes of 117 patients at the subsequent pregnancy [n(%)]
变量系数标准误差95%CIχ2P
UAE:子宫动脉栓塞术.
出血量0.0000.000-0.001~0.0010.184>0.05
前置胎盘-0.2020.641-1.536~1.0120.102>0.05
分娩方式-2.2281.538-7.125~0.0143.782>0.05
UAE1.6290.6530.361~2.9456.312<0.05
Tab 3 Firth logistic regression analysis on the risk factors for cesarean scars pregnancy after postpartum hemorrhage
组别n年龄(岁)分娩孕周孕次产次剖宫产*出血量(mL)出血原因*两次妊娠间隔(月)
01前置胎盘子宫收缩乏力胎盘植入凝血功能障碍
“—”:无相关数据;*确切概率法.UAE:子宫动脉栓塞术.
UAE组1527.3±6.036.0(35.0, 38.9)2(1, 3)1328(53.3)2000(1050, 2200)4(26.7)9(60.0)2(13.3)0(0.0)36.0(24.0, 48.0)
对照组2026.8±3.937.2(35.3, 39.8)1(1, 2)17320(100.0)1000(625, 1200)8(40.0)7(35.0)3(15.0)2(10.0)37.5(24.8, 45.0)
t/Z/χ2-0.311-0.867-1.356-2.560-0.184
P>0.05>0.05>0.05>0.05<0.01<0.05>0.05>0.05>0.05>0.05>0.05
Tab 4 Previous pregnancy and postpartum hemorrhage in 35 patients with subsequent pregnancy and delivery [${\bar x}$±sM(Q1, Q3)或n(%)]
组别n分娩孕周胎儿体质量(g)剖宫产*子宫切除*复发产后出血主要出血原因*出血量(mL)并发症*
子宫收缩乏力胎盘植入妊娠期糖尿病子痫前期
“—”:无相关数据;*确切概率法.UAE:子宫动脉栓塞术.
UAE组1538.4(35.1, 39.1)3100(2230.0, 3450.0)12(80)3(20.0)7(46.7)2(13.3)5(33.3)500(330, 1780)3(20)0(0)
对照组2038.6(37.5, 39.0)3325(2887.5, 3750.0)20(100)0(0.0)2(10.0)2(10.0)0(0.0)400(350, 500)2(10)0(0)
Z2-0.468-1.384-0.857
P>0.05>0.05>0.05<0.05<0.05>0.05<0.01>0.05>0.05
Tab 5 Clinical outcomes of 35 patients at the subsequent delivery [M(Q1, Q3)或n(%)]
变量系数标准误差95%CIχ2P
UAE:子宫动脉栓塞术.
UAE3.5741.6960.883~8.6037.258<0.01
出血量-0.0010.001-0.002~0.0010.606>0.05
分娩方式-0.2221.107-2.311~1.8000.048>0.05
Tab 6 Firth logistic regression analysis on the risk factors for accreta
变量系数标准误差95%CIχ2P
UAE:子宫动脉栓塞术.
UAE2.6091.1050.686~4.9257.264<0.01
出血量0.0000.001-0.002~0.0010.274>0.05
分娩方式-1.1351.094-3.255~0.7881.325>0.05
Tab 7 Firth logistic regression analysis on the risk factors for recurrent postpartum hemorrhage
变量系数标准误差95%CIχ2P
UAE:子宫动脉栓塞术.
UAE3.0441.7100.236~8.0814.563<0.05
出血量-0.0010.001-0.002~0.0010.476>0.05
分娩方式0.2681.147-1.855~2.4410.064>0.05
Tab 8 Firth logistic regression analysis on the risk factors for cesarean hysterectomy
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