Utilization and Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study

Arndt, Linzi; Newsome, Janice; Guo, Mengzhou; Majdalany, Bill S.; Gichoya, Judy Wawira; Platner, Marissa; Garcia-Reyes, Kirema; Duszak, Richard; Yuan, Lan; Risk, Benjamin B.; Cwiak, Carrie; Kokabi, Nima

doi:10.1016/j.jvir.2021.12.004

Cited by 8 publications

(3 citation statements)

References 44 publications

(57 reference statements)

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“…Most studies have investigated the risk factors and prognosis of peripartum hysterectomy for PPH by dividing patients into groups that underwent peripartum hysterectomy and those that did not [12][13][14]. In addition, some studies have shown that UAE is highly effective in preventing peripartum hysterectomy [15], while other studies have shown the effectiveness of UAE and BBT and that these methods can lower the incidence of peripartum hysterectomy [10,16,17]. However, few studies have analyzed cases in which surgery was performed after failure of second-line treatments, such as BBT or UAE that were performed rst.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and prognosis of postpartum hemorrhage according to management protocol: A 11-year retrospective study from two referral centers

Jung,

Kim,

Shin

et al. 2024

Preprint

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Background No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes between patients with PPH who underwent surgical and non-surgical treatments. Methods This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical intervention (group 1, n = 159), surgical intervention (group 2, n = 45), and surgical intervention after failure of non-surgical intervention (group 3, n = 26) groups. Results In each group, the initial heart rate and body temperature were significantly different (92.2 ± 20.7, 112.6 ± 30.4, and 102.1 ± 23.3 beats per minute, p < 0.001 and 37.3 ± 0.8°, 36.9 ± 0.9°, and 37.2 ± 0.9°, p = 0.016, in groups 1–3, respectively). Among the causes of PPH, uterine atony combined with other causes showed a significant difference among the three groups (32 cases (20.1%), 8 cases (17.8%), and 14 cases (53.8%), p = 0.003 in groups 1–3, respectively). Mean duration of hospitalization and intensive care unit admission rate were significantly different between the groups (4.1 ± 1.7, 8.7 ± 10.3, and 10.4 ± 13.6 days, p < 0.001 and 6 cases (3.8%), 17 cases (37.8%), and 12 cases (46.2%), p < 0.001 in groups 1–3, respectively). Hysterectomy and disseminated intravascular coagulopathy rates were significantly higher in group 3 than in group 2 [(19 cases (73.1%) and 23 cases (51.1%), x2 = 3.291, p = 0.047); 18 cases (69.2%) and 19 cases (42.2%), x2 = 4.817, p = 0.028), respectively]. Conclusions In patients with PPH and an initial increased heart rate or decreased body temperature and in those with causes combined with uterine atony, immediate surgical intervention improves the prognosis. Postoperative complications increased when surgery was performed after failure of non-surgical interventions.

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Section: Introductionmentioning

confidence: 99%

Outcomes and prognosis of postpartum hemorrhage according to management protocol: A 11-year retrospective study from two referral centers

Jung,

Kim,

Shin

et al. 2024

Preprint

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“…[6,7] Uterine artery embolization (UAE) has been widely used for treating postpartum hemorrhage, cesarean scar pregnancy, placenta accrete spectrum. [8][9][10] Some researchers have made attempts to use prophylactic UAE to prevent hemorrhage during the termination of mid trimester pregnancy with placenta previa, [6] but the problem is that the overuse of UAE may bring more complications such as severe pain after UAE, ovarian failure, irregular menstruation or affected fertility. [6,[11][12][13] In our study, we retrospectively analyzed the pregnant women with placenta previa who underwent termination of mid-pregnancy in our hospital from January 1st, 2019, to December 31th, 2019, and discussed the labor inducing methods used for them.…”

Section: Introductionmentioning

confidence: 99%

The method for termination of mid-trimester pregnancy with placenta previa: A case study

Long

et al. 2022

Medicine

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Background: Prenatal bleeding is very dangerous for pregnant women with placenta previa during termination of pregnancy in the mid-trimester. Traditionally, cesarean section or hysterectomy is used to stop bleeding. This study aims to investigate the method for termination of mid-trimester pregnancy with placenta previa, especially emergency uterine artery embolization (UAE) combined with cervical double balloon (CDB).Methods: A retrospective study was conducted based on 261 cases of mid-pregnancy termination in our hospital, where 34 cases with placenta previa were set as the observation group, and the remaining 227 cases were set as control group. At first, the termination method of Mifepristone combined with Misoprostol/Ethacridine Lactate was adopted. If the volume of prenatal bleeding was up to 400 mL, emergency uterine artery embolization (UAE) was implemented to stop bleeding, then cervical double balloon (CDB) was used to promote cervical ripening. Receiver operating characteristic (ROC) curves analysis was performed to assess the accuracy in predicting the length of placental edge crossed the cervical os for prenatal bleeding.Results: The number of gravidity/parities, the rate of cesarean section, the medical cost, the rate of previous cesarean section were all higher in the observation group than in the control group (P < .05). The volume of prenatal hemorrhage, postpartum hemorrhage, the rate of puerperal morbidity, emergency UAE rate and ICU rate were higher in the observation group than in the control group (P < .05). There were 4 cases showing prenatal hemorrhage up to 400 mL and undergoing emergency UAE + CDB in the observation group, while there were no such cases in the control group (P < .05). An optimal cut-off value of 1.7cm for the length of placental edge crossed the cervical os in diagnosing prenatal hemorrhage demonstrated sensitivity and specificity of 75.0% and 86.7%, respectively (area under the ROC curve, 0.858). Conclusion:The combined therapy of mifepristone and Misoprostol/Ethacridine Lactate was useful for termination of midtrimester pregnancy with placenta previa, and attention needs to be attached to prenatal hemorrhage during labor induction. Emergency UAE + CDB is a good combination method to treat prenatal hemorrhage and promote cervical ripening during the induction.

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“…Optimal candidates for UAE encompass individuals afflicted with symptomatic fibroids, who express a desire for uterine preservation and/or seek alternatives to surgical procedures (2). Recent years have seen the extensive use of UAE in addressing conditions, such as uterine fibroids (UFs), postpartum hemorrhage (PPH), and cesarean scar pregnancy (CSP) (3)(4)(5). UAE has demonstrated efficacy in symptom improvement with a low incidence of major complications.…”

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confidence: 99%

Pregnancy rate and outcomes after uterine artery embolization for women: a systematic review and meta-analysis with trial sequential analysis

Yan,

Zhou,

et al. 2023

Front. Med.

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ObjectiveThe assessment of the relative impacts of uterine artery embolization (UAE) treatment for female patients is a critical field that informs clinical decisions, yet there is a noticeable scarcity of high-quality, long-term comparative studies. This meta-analysis aimed to focus on the pregnancy rate and outcomes in female patients following UAE and to conduct subgroup analyses based on different patient populations or various control treatments.MethodsA systematic literature search was conducted on 2 August 2023 through the Web of Science, PubMed, Embase, and the Cochrane Library of Clinical Trials for all potential studies. Relative risks (RRs) with 95% confidence intervals (CIs) were applied to compare pregnancy rates and outcomes between the UAE group and the control group. Heterogeneity was evaluated statistically by using the chi-square-based Cochran’s Q test and Higgins I2 statistics, and 95% prediction interval (PI). Software R 4.3.1 and Stata 12.0 were used for meta-analysis. The trial sequential analysis (TSA) was performed with TSA v0.9.5.10 Beta software.ResultsA total of 15 eligible studies (11 cohort studies, 3 randomized controlled trials, and 1 non-randomized clinical trial) were included in this meta-analysis. The overall results revealed that UAE significantly decreased postoperative pregnancy rate [RR (95% CI): 0.721 (0.531–0.979), 95% PI: 0.248–2.097] and was associated with an increased risk of postoperative PPH [RR (95% CI): 3.182 (1.319–7.675), 95% PI: 0.474–22.089]. Analysis grouped by population indicated that UAE decreased the risk of preterm delivery [RR (95% CI): 0.326 (0.128–0.831), p = 0.019] and cesarean section [RR (95% CI): 0.693 (0.481–0.999), p = 0.050] and increased the risk of placenta previa [RR (95% CI): 8.739 (1.580–48.341), p = 0.013] in patients with UFs, CSP, and PPH, respectively. When compared with myomectomy, HIFU, and non-use of UAE, UAE treatment was associated with the reduced risks of preterm delivery [RR (95% CI): 0.296 (0.106–0.826)] and cesarean section [(95% CI): 0.693 (0.481–0.999), p = 0.050] and increased placenta previa risk [RR (95% CI): 10.682 (6.859–16.636)], respectively.ConclusionUAE treatment was associated with a lower postoperative pregnancy rate and increased risk of PPH. Subgroup analysis suggested that UAE was shown to decrease the risk of preterm delivery and cesarean section and increase placenta previa risk.Systematic review registration:https://www.crd.york.ac.uk/prospero/, Identifier CRD42023448257.

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Utilization and Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study

Cited by 8 publications

References 44 publications

Outcomes and prognosis of postpartum hemorrhage according to management protocol: A 11-year retrospective study from two referral centers

Outcomes and prognosis of postpartum hemorrhage according to management protocol: A 11-year retrospective study from two referral centers

The method for termination of mid-trimester pregnancy with placenta previa: A case study

Pregnancy rate and outcomes after uterine artery embolization for women: a systematic review and meta-analysis with trial sequential analysis

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