Uterine artery embolization for Postpartum Hemorrhage: Intermediate Length follow-up and Assessment of Risk Factors for Failure

Wednesday, April 2, 2025

11:33 AM – 11:42 AM CT

Location: Music City Center, 204

Presenting Author(s)

Mihir Khunte

Student
Warren Alpert Medical School of Brown University, United States

Author/Co-author(s)

HC

Huanwen Chen, MD

Resident
Division of Interventional Neuroradiology, Department of Radiology, University of Maryland Medical Center, United States
DG

Dheeraj Gandhi, MD

Professor of Diagnostic Radiology and Nuclear Medicine
University of Maryland School of Medicine, United States
AM

Ajay Malhotra, MBBS, MD, MMM

Professor of Neuroradiology
Yale University School of Medicine, United States
SA

Sun-Ho Ahn, MD

Associate Professor
Warren Alpert Medical School of Brown University, United States

Purpose: Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality in the United States. Uterine artery embolization (UAE) is a treatment option that allows for uterine preservation, unlike more invasive procedures such as hysterectomy. While technical and short-term outcomes have been described, longer-term outcome data is lacking. This study aims to describe longer term clinical success of UAE for PPH and identification of risk factors for clinical failure.

Materials and Methods: The 2016-2021 U.S. National Readmissions Database (NRD) was queried to identify patients who underwent UAE after PPH. Initial hospitalization outcomes were assessed and compared between patients who were successfully treated with UAE and those who failed treatment. Failure of treatment was defined as patients who required a hysterectomy during the same hospitalization for cessation of bleeding and/or were not discharged home. Patients who had a successful UAE were followed for the calendar year for non-elective hospital readmissions. The risk of readmissions was calculated using Cox regression models adjusting for major maternal and delivery risk factors.

Results:

There were 7,979 patients treated with UAE for PPH. 4106 (51.4%) and 1090 (13.7%) patients required transfusions of blood products and salvage hysterectomy, respectively during the same hospital stay. The rate of non-routine discharge and mortality was 6.02% and 0.73%, respectively. The 30-day mortality after discharge was 0.03%. Among the 6,440 (80.7%) patients with successful UAE, the overall one-, three- and six-month readmission rates were 5.4%, 6.8%, and 7.8%, respectively. The one-, three- and six-month readmission rates due to severe hemorrhage (transfusion, hysterectomy, or repeat UAE) were 1.2%, 1.6%, and 1.9%, respectively. Patients with placenta accreta spectrum were at a significantly increased risk of readmission with severe hemorrhage (HR 3.49 [95%CI 1.73 – 7.07], p=< 0.001). Patients with preeclampsia/eclampsia had a significantly higher risk of overall hospital readmissions than those without (adjusted hazards ratio 1.46 [95%CI 1.05 to 2.03], p= 0.023) but did not have a significantly higher risk of readmissions due to severe hemorrhage (HR 1.62 [95%CI 0.77 - 3.37], p = 0.20).

Conclusion:

UAE for PPH has a highly successful acute and intermediate length clinical success. The vast majority of patients did not require further inpatient treatment. Nonetheless, patients with PPH secondary to placenta accreta spectrum are at higher risk for clinical failure and may need to be closely monitored.