New research to be presented at the Society of Interventional Radiology (SIR) annual scientific meeting (23–27 March, Salt Lake City, USA) has found early intervention with uterine artery embolization (UAE) can help women avoid hysterectomy due to severe bleeding after childbirth.
“These findings are important and may help more women avoid hysterectomy and other very serious complications of uncontrolled haemorrhage,” said lead author Younes Jahangiri (Michigan State University, East Lansing, USA), a resident interventional/diagnostic radiologist. “As the medical community looks for ways to provide better care for women to address maternal health and peri-partum care, this is one more option on the table that could help many women.”
The study was a retrospective review of 66 patients with a median age of 31 who underwent UAE for uncontrolled postpartum haemorrhage at a single, high-volume medical centre between 2014–2022. UAE successfully controlled postpartum haemorrhaging in 62 of the 66 patients (94%). Four patients required hysterectomies to stop the bleeding, all of whom lost at least 2,400ml blood prior to presentation for UAE and symptoms of diffuse intravascular coagulopathy, a clotting abnormality that can happen after large-volume haemorrhage due to rapid consumption of clotting factors.
Postpartum haemorrhage is a rare, but can be a potentially deadly complication of childbirth. To stop it, obstetricians will initially use conservative approaches to replace the lost blood or to promote clotting. If these measures are insufficient, hysterectomy is usually performed. Alternatively, interventional radiologists can be brought in to perform UAE, injecting tiny particles into the arteries that supply blood to the uterus using fluoroscopic imaging guidance. Once placed in the arteries, the particles temporarily block blood flow to stem uterine bleeding.
“Based on these findings, we would encourage obstetricians to involve interventional radiologists early, to be ready to perform UAE if more conservative approaches are not managing postpartum haemorrhage,” said senior author James Morrison (Michigan State University, East Lansing, USA).
Researchers in this study found a 36% incidence of post-embolization syndrome, which presents with abdominal pain and flu-like symptoms. The study found that it was more likely to occur in patients who experienced greater blood loss before embolization.
Jahangiri, Morrison and their colleagues plan to expand their research to include multiple institutions and ultimately to conduct a prospective study that examines longer-term outcomes of UAE.
