Fertility after embolization of the uterine arteries to treat obstetrical hemorrhage: a review of 53 cases.

OBJECTIVE: To study subsequent fertility of patients who underwent embolization of the uterine arteries to treat postpartum hemorrhage. DESIGN: Retrospective cohort study between January 2000 and June 2006 with two patient groups: exposed and nonexposed to embolization for postpartum hemorrhage. SETTING: Level 3 maternity unit. PATIENT(S): Fifty-three patients exposed to embolization and 106 nonexposed patients were included and paired according to several criteria: date of delivery, age, parity, whether the pregnancy was spontaneous or with fertility assistance, and mode of delivery. INTERVENTION(S): None. MAIN OUTCOMES MEASURE(S): Occurence of pregnancy. RESULT(S): Among patients exposed to embolization, 14 had been exposed to pregnancy and 12 had been pregnant. There was no statistically significant difference of occurrence of pregnancy between the nonembolized and embolized groups (P=.30). CONCLUSION(S): According to the results, it seems that embolization does not alter subsequent fertility. This study nevertheless suggests a trend toward fewer pregnancies in the embolization group and reports three severe complications in that group. This trend deserves to be explored by further studies with higher statistical power. However, even if it would be difficult to provide complete reassurance to patients who have undergone embolization, better information regarding their subsequent fertility and potential risks could relieve them of their worries regarding a new pregnancy.

Forceps delivery and the use of synthetic opioid analgesia during epidural anaesthesia.

OBJECTIVE: To verify whether the use of sufentanil during obstetric epidural anaesthesia (EA) was accompanied by an increase in the rate of instrumental extraction. STUDY DESIGN: We made a retrospective comparison of deliveries that occurred during two 3-year periods (1993-1995, and 1997-1999), before and after the introduction of sufentanil into our protocol for epidural anaesthesia. RESULTS: The first period covered 4694 deliveries compared with 5310 in the second; for these periods, the EA rate rose from 48.55 to 63.36% (P=0.0001). The rates of uncomplicated vaginal delivery, forceps delivery and caesarian section over the two periods were 70.24, 12.76 and 17% versus 67.08, 14.41 and 18.51%, respectively: the differences were statistically significant. The indications for the use of forceps did not differ during the two periods. During vaginal delivery, the rate of forceps use as a function of EA administration/non-administration was remarkably constant over the two periods: 25.8% with EA versus 6.2% without EA in the first period compared with 24.9 and 6.2% in the second period. The forceps delivery rate was unaffected by the fact that EA was carried out by an anaesthetist specialised in obstetrics. CONCLUSION: The addition of sufentanil to our protocol for EA has not altered the practice of instrumental extraction in our department. With EA, the rate of forceps delivery is multiplied by 4, irrespective of the protocol used.