Endometritis risk factors after arterial embolisation for postpartum haemorrhage

Figures & data

Table 1. Twenty patients background.

	Age	P	Week	Mode	Cause	U or B /vessel (artery)	Bleeding volume (mL)	Extra
Non-Em group^a	39	0	39w0d	VD	Laceration	U/internal iliac	463	–
	36	0	41w5d	CS	Atonic	U/internal iliac U/uterine	1515	–
	45	0	38w3d	CS	Previa	B/uterine	1524	–
	41	0	39w3d	VD	Atonic	B/uterine	1624	–
	46	0	35w3d	CS	Atonic	B/uterine	1700	–
	36	1	36w5d	CS	Atonic	B/internal iliac	1854	–
	40	1	39w6d	VD	Atonic	B/uterine	2459	–
	38	1	40w2d	CS	Atonic	B/uterine	2520	–
	41	0	38w6d	CS	Atonic	B/uterine	2920	–
	40	1	37w4d	CS	Atonic	B/uterine	4302	–
	35	0	41w3d	CS	Atonic	U/uterine	510	+
	37	0	40w2d	OVD	Atonic	B/internal iliac	894	+
Em group^b	44	9	39w2d	CS	Atonic	B/uterine	810	–
	33	0	40w2d	VD	Atonic	B/uterine	2790	–
	39	0	36w3d	CS	Atonic	B/uterine	1800	+
	37	0	40w1d	VD	Atonic	B/uterine	2523	+
	41	0	39w4d	OVD	Laceration	U/uterine	2850	+
	39	2	25w3d	CS	Previa	B/uterine	3000	+
	38	0	39w3d	VD	Atonic	B/uterine	3002	+
	40	0	39w6d	VD	Laceration	B/uterine	3942	+

A: artery; atonic: atonic bleeding; B: bilateral; CS: caesarean section; extra: the presence of extravasation of contrast medium on computer tomography scan; OVD: operative vaginal delivery; P: parous; previa: previa placenta; U: unilateral; VD: vaginal delivery.

^a Non-Em group: the group which was not diagnosed as endometritis.

^b Em group: the group which was diagnosed as endometritis.

Table 2. Patient’s background.

Variables	Overall (n = 20)	Non-Em group^a (n = 12)	Em group^b (n = 8)	p Value
Age^c, years	39.0 (33–46)	39.5 (35–46)	38.9 (33–44)	.687
BMI^c, kg/m^2	19.6 (15.9–29.9)	20.4 (16.6–26.6)	19.4 (19.9–29.9)	.860
Parity^c	0.0 (0–2)	0.0 (0–1)	0.0 (0–2)	.444
Gestational week^c, w	39.4 (25.4–41.7)	39.2 (35.4–41.7)	39.5 (25.4–40.2)	.787
Infant birth weight^c,e, g	3285 (670–5830)	3554 (2460–5830)	2959 (670–4928)	.157
CS operation time^c, min	74.0 (46.0–165.0)	76.0 (46.0–165.0)	64.0 (58.0–77.0)	.497
Labour duration for VD^c, min	706.0 (151.0–1677.0)	516.0 (151.0–1677.0)	706.0 (207.0–1249.0)	.905
Bleeding volume^c, mL	2156.5 (463.0–4550.0)	1662.0 (463.0–4302.0)	2820.0 (810.0–4550.0)	.057
Blood transfusion^c, Units	9 (0–20)	8 (0–18)	11 (4–20)	.200
Length of hospital stay^c, days	13 (8–50)	11 (8–50)	25 (10–41)	.013*
Time to AE from the delivery^c, days	0 (0–15)	0 (0–15)	0 (0–1)	.286
Twin^d	4 (20.0)	3 (25.0)	1 (12.5)	.619
ART^d	8 (40.0)	4 (36.4)	4 (57.1)	.630
Smoking history^d	2 (10.0)	1 (8.3)	1 (14.2)	1.000
GBS^d	2 (10.0)	1 (11.1)	1 (16.7)	1.000
GDM^d	3 (15.0)	1 (8.3)	2 (25.0)	.537
HDP^d	5 (25.0)	3 (25.0)	2 (25.0)	1.000
PROMd	2 (10.0)	1 (8.3)	1 (12.5)	1.000
Mode VD, CS, OVD^d	7, 11, 2 (35.0, 55.0, 10.0)	3, 8, 1 (25.0, 66.7, 8.3)	4, 3, 1 (50.0, 37.5, 12.5)	.534
Extravasation^d,f	8 (40.0)	2 (16.7)	6 (75.0)	.019*
Embolic blood vessels^d, BUA, BIA, UA	13, 2, 5 (65.0, 10.0, 25.0)	7, 2, 3 (58.3, 16.7, 25.0)	6, 0, 2 (75.0, 0.0, 25.0)	.796
Bleeding volume more than 2500 mL^d	8 (40.0)	2 (16.7)	6 (75.0)	.019*
Endometritis^d	8 (40.0)	–	–	–

AE: arterial embolisation; ART: assisted reproductive technology pregnancy; ASA-PS: American Society of Anaesthesiologists Physical Status; BIA: bilateral internal iliac artery; BMI: body mass index; BUA: bilateral uterine artery; CS: caesarean section; GBS: group B streptococcus; GDM: gestational diabetes mellitus; HDP: hypertension disorder in pregnancy; OVD: operative vaginal delivery; UA: unilateral artery; VD: vaginal delivery.

* p Value <.05.

^a Non-Em group: the group which was not diagnosed as endometritis.

^b Em group: the group which was diagnosed as endometritis.

^c Data are presented as median (range) for continuous variables.

^d Data are presented as number (%) for nominal variables.

^e Birth weight of infant: as for twin pregnancy, the sum of birth weight of infant was showed.

^f Extravasation of contrast medium was diagnosed by radiologist using computer tomography before the AE procedure.

Figure 1. Multivariate analysis results using the classification and regression tree model. Contrast medium extravasation is the highest risk factor for EM development (relative risk: 2.5 compared to those without EM). The second leading risk factor is a bleeding volume greater than 2500 mL. ^aExtravasation of contrast medium in a computer tomography scan.

Figure 2. The receiver operating characteristic (ROC) curve of the EM prediction model is created using two factors: extravasation of contrast medium and a bleeding volume greater than 2500 mL (the area under the ROC curve: 0.771, 95% confidence interval: 0.585–0.956, sensitivity: 87.5%, specificity: 66.7%, accuracy: 0.75).