Primary postpartum hemorrhage: outcome of uterine artery embolization

Aoki, Makoto; Tokue, Hiroyuki; Miyazaki, Masaru; Shibuya, Kazuhiko; Hirasawa, Satoshi; Oshima, Kiyohiro

doi:10.1259/bjr.20180132

Cited by 37 publications

(28 citation statements)

References 17 publications

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“…UAE is considered appropriate in the treatment of PPH because it reduces bleeding, avoids hysterectomy, and preserves fertility with high success rates and tolerable side effects. 8,36,37 However, the procedure entails risks such as PAS in the subsequent pregnancy. Although there is little evidence, uterine compression sutures and uterine balloon tamponade (UBT) seem not to be associated with a higher risk of PAS in the subsequent pregnancy when compared with UAE.…”

Section: Discussionmentioning

confidence: 99%

“…4 Treatment strategies include pharmacological measures (eg, oxytocin administration), intrauterine tamponade (eg, Bakri balloon or Sengstaken-Blakemore tube), uterine artery ligation, hysterectomy, uterine compression sutures, and uterine artery embolization (UAE). [5][6][7][8][9][10][11][12] A few publications have shown higher rates of preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) among women who became pregnant after UAE for PPH. However, these obstetric outcomes were not investigated with non-UAE cases in these studies.…”

Section: Introductionmentioning

confidence: 99%

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<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Jitsumori¹,

Endo²,

Hara³

et al. 2020

IJWH

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Background: Uterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case-control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE. Methods: We retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: We used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01). Conclusion: Our results suggest that previous UAE is a significant risk factor for PAS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Jitsumori¹,

Endo²,

Hara³

et al. 2020

IJWH

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“…Characteristics considered to be potential confounders for the association between use of intrauterine balloon tamponade or use of uterine artery embolization, or characteristics considered to be risk factors for the occurrence of the primary outcome measure alone, were included as covariates in the propensity score model. 17 Characteristics included as covariates that were available at the moment the clinician decided to use intrauterine balloon tamponade or perform uterine artery embolization were: maternal age, gestational age, parity (nulliparity or multiparity), preeclampsia, multiple pregnancy, prior cesarean birth, mode of birth (vaginal birth or cesarean section), cause of hemorrhage (categorized as uterine atony, retained placenta, abnormally invasive placenta and other causes [composite of placenta previa, placental abruption and uterine rupture due to small numbers]), the presence of coagulopathy (defined as a fibrinogen level ≤2 g/L during bleeding), symptoms of shock (defined as at least one measurement of a systolic blood pressure ≤90 mm Hg and/or heart rate ≥120 beats per minute during bleeding), volume of blood loss at time were selected a priori based on the literature 4,5,7,12,13,[18][19][20][21][22][23] and clinical reasoning. Missing variables were imputed using median and logically derived imputation (see Appendix S2 for the rationale behind the imputation method applied per missing variable).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Uterine artery embolization may be used to manage persistent postpartum hemorrhage that demands immediate intervention before proceeding to hysterectomy but it is considered a relatively costly and invasive procedure that is prone to complications (eg, post‐embolization syndrome, thrombo‐embolic events or uterine necrosis) . On the other hand, intrauterine balloon tamponade has emerged as an inexpensive and less invasive option to control ongoing bleeding .…”

Section: Introductionmentioning

confidence: 99%

“…6 Uterine artery embolization may be used to manage persistent postpartum hemorrhage that demands immediate intervention before proceeding to hysterectomy but it is considered a relatively costly and invasive procedure that is prone to complications (eg, post-embolization syndrome, thrombo-embolic events or uterine necrosis). [7][8][9][10] On the other hand, intrauterine balloon tamponade has emerged as an inexpensive and less invasive option to control ongoing bleeding. [11][12][13] Insertion of an intrauterine balloon for the purpose of tamponade during postpartum hemorrhage could potentially obviate the need for uterine artery embolization, and reduce healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

Ramler

Henriquez

Akker

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to compare the outcomes of women who were initially managed by intrauterine balloon tamponade or uterine artery embolization because of persistent postpartum hemorrhage demanding an immediate intervention to control bleeding. Material and methods Propensity score‐matched cohort study including women who had intrauterine balloon tamponade or uterine artery embolization as initial management strategy to control persistent postpartum hemorrhage, that is, refractory to first‐line therapy combined with at least one uterotonic agent. The primary outcome measure was a composite of peripartum hysterectomy and/or maternal mortality. Secondary outcomes measures were total volume of blood loss and total number of packed red blood cells transfused. Results Our 1:1 propensity score‐matched cohort comprised of 50 women who had intrauterine balloon tamponade and 50 women who underwent uterine artery embolization at a blood loss between 1000 and 7000 mL. There was no statistically significant difference in the hysterectomy risk between the two groups (n = 6 in each group, odds ratio [OR] 1.00, 95% confidence interval [CI] .30‐3.34), in total volume of blood loss (median 4500 mL, interquartile range [IQR] 3600‐5400) for balloon vs 4000 mL (IQR 3250‐5000) for embolization, P = 0.382) or in total units of packed red blood cells transfused (median 7 (IQR 5‐10) for balloon vs 6 [IQR 4‐9] for embolization, P = 0.319). Fifteen women (30%) who were initially managed by an intrauterine balloon still underwent uterine artery embolization, of whom one had an embolization‐related thrombo‐embolic event. Maternal mortality occurred in neither of the intervention groups. Conclusions No difference in the risk of peripartum hysterectomy and/or maternal death was observed between women who had intrauterine balloon tamponade and women who underwent uterine artery embolization as an initial management for persistent postpartum hemorrhage. Although this study was underpowered to demonstrate equivalence, our study design provides a framework for future research in which intrauterine balloon tamponade may prove to be a suitable intervention of first choice in the management of persistent postpartum hemorrhage.

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Characteristics and outcomes of patients with postpartum hemorrhage undergoing transcatheter arterial embolization: A nationwide observational study

Kamijo,

Nakajima,

Shigemi

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo elucidate the demographics, clinical characteristics, and outcomes of patients with postpartum hemorrhage (PPH) who underwent transcatheter arterial embolization (TAE).MethodsWe conducted a retrospective observational study using the Japanese Diagnosis Procedure Combination inpatient database, which covers roughly 90% of all tertiary emergency hospitals in Japan, between April 2012 to March 2020. We identified patients with PPH who underwent TAE using the Japanese medical procedure status and code, and the device or drug code. We examined the patient characteristics, interventions administered, and clinical outcomes.ResultsAmong 64 893 patients diagnosed with PPH, we identified 2705 (4.2%) patients with PPH who underwent TAE. The most common cause of PPH was uterine atony (68.7%), followed by disseminated intravascular coagulation after labor (30.0%) and placenta accreta spectrum disorders (23.4%). The proportion of patients who underwent repeat TAE and a hysterectomy was 64 (2.4%) and 188 (7.0%), respectively. Among hysterectomies (n = 188), 26 (13.8%) had the procedure performed before TAE, 73 (38.8%) underwent hysterectomy on the same day as TAE, and 89 (47.4%) had the procedure conducted after TAE. Of those who underwent a hysterectomy after TAE (n = 89), 33 (37%) were performed more than 1‐week after initial TAE. Overall in‐hospital mortality was 14/2705 (0.5%).ConclusionEven if hemostasis is achieved through TAE, one must be mindful that a hysterectomy may become necessary more than 1 week after the procedure. These results could be helpful in clinical decision making and providing patients with additional treatment options for PPH that preserve patient fertility.

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Primary postpartum hemorrhage: outcome of uterine artery embolization

Cited by 37 publications

References 17 publications

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

<p>Obstetric Outcomes of Pregnancy After Uterine Artery Embolization</p>

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score‐matched cohort study

Characteristics and outcomes of patients with postpartum hemorrhage undergoing transcatheter arterial embolization: A nationwide observational study

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