Dans cette Ă©tude cas-tĂ©moins, les effets Ă  long terme gynĂ©cologiques, reproductifs et sexuels après embolisation de l’artère utĂ©rine (EAU) pour hĂ©morragie post-partum (HPP) ont Ă©tĂ© Ă©valuĂ©s. L’Ă©tude a Ă©tĂ© rĂ©alisĂ©e au CHUV Ă  Lausanne de 2003 Ă  2013. Chaque patiente dont l’accouchement a Ă©tĂ© compliquĂ© par une HPP et traitĂ© par une EAU a Ă©tĂ© incluse et comparĂ©e Ă  un groupe tĂ©moin de patientes dont l’accouchement n’a pas Ă©tĂ© compliquĂ© d’une HPP.
Les cas ont Ă©tĂ© matchĂ©s pour l’âge maternel, la paritĂ©, l’origine ethnique, l’annĂ©e et le mode d’accouchement, le poids Ă  la naissance et l’âge gestationnel dans un rapport de 1 pour 3. Un total de 77 patientes traitĂ©es par EAU pour une l’HPP ont Ă©tĂ© identifiĂ©es dans notre base de donnĂ©es obstĂ©tricale. Parmi elles, 63 ont Ă©tĂ© incluses et comparĂ©es Ă  189 patientes contrĂ´les sans HPP.
Huit ans en moyenne après un accouchement, les patientes avec HPP traitĂ©es par EAU avaient les mĂŞmes symptĂ´mes gynĂ©cologiques et sexuels que les patientes contrĂ´les sans HPP. Étant donnĂ© que les suites d’une grossesse ultĂ©rieure après EAU Ă©taient similaires Ă  celles du groupe contrĂ´le, les patientes peuvent ĂŞtre rassurĂ©es quand Ă  une planification de futures grossesses. Cependant, la rĂ©currence de l’HPP est accrue et les accouchements ultĂ©rieurs doivent ĂŞtre gĂ©rĂ©s activement en consĂ©quence. L’impact psychologique de l’HPP ne doit pas ĂŞtre sous-estimĂ© et justifie des investigations complĂ©mentaires, comme cela a Ă©tĂ© rĂ©alisĂ© dans la deuxième partie de cette Ă©tude.
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In this case control study, long‑term gynecological, reproductive and sexual outcomes after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) were evaluated. The study was performed in a single referral hospital for PPH in Lausanne from 2003 to 2013. Each woman whose delivery was complicated by PPH and treated by UAE was included, and compared to a control group of women whose delivery was uncomplicated. Cases were matched by maternal age, parity, ethnicity, year and mode of delivery, birth weight and gestational age in a 1–3 ratio. A total of 77 patients treated by UAE for PPH were identified in our obstetrical database. Among them, 63 were included and compared to 189 matched patients (no PPH). The mean interval time between UAE and this study was 8.1 years. Time to menstrual cycle recovery after delivery (3.9 vs 5.6 months, p = 0.66), spotting (7.9% vs 7.2%, p = 0.49), dysmenorrhea (25.4% vs 22.2%, p = 0.60) and amenorrhea (14.3% vs 12.2%, p = 0.66) were similar between the two groups. There was no difference in the FSFI score between the groups (23.2 ± 0.6 vs 23.8 ± 0.4; p = 0.41). However, the interval time to subsequent pregnancy was longer for patients after UAE than the control group (35 vs 18 months, p = 0.002). In case of pregnancy desire, the success rate was lower after UAE compared to controls (55% vs 93.5%, p < 0.001). The rate of PPH was higher in those with previous PPH (6.6% vs 36.4%, p = 0.010). Patients treated by UAE for PPH did not report higher rates of gynecological symptoms or sexual dysfunction compared to patients with uneventful deliveries. The inter‑pregnancy interval was increased and the success rate was reduced. In subsequent pregnancies, a higher rate of PPH was observed in those that underwent UAE.