The risks of adverse prenatal health outcomes are significantly increased among women undergoing uterine artery embolization (UAE) during their first delivery, according to a recent study published in Human Reproduction Open.
Takeaways
- Women who undergo uterine artery embolization (UAE) during their first delivery have significantly higher risks of obstetrical complications in subsequent pregnancies, including recurrent postpartum hemorrhage (PPH) and placenta accreta spectrum (PAS).
- The UAE group showed increased odds for several severe maternal outcomes in the second delivery, such as preterm birth, Bakri tamponade balloon use, hysterectomy, and maternal intensive care unit (ICU) admission.
- Infants born to women who had UAE in their first delivery faced higher risks of major congenital malformations, adverse neonatal events, and neonatal ICU admissions.
- Women who had UAE during their first delivery had a lower rate of second deliveries (39.9 per 1000-person years) compared to those who did not undergo UAE (53.1 per 1000-person years).
- The study recommends further investigation into the mechanisms behind these increased risks to refine UAE procedures and improve outcomes for future pregnancies.
Postpartum hemorrhage (PPH), defined as 1000 ml or more of blood loss within 24 hours after delivery, is present in 4% to 6% of deliveries, with severe PPH linked to approximately 140,000 deaths worldwide per year. Common PPH treatment options include uterotonic drug administration and uterine compression, but UAE may be used when conservative methods fail.
UAE is considered a safe alternative to hysterectomy for severe PPH treatment, with a success rate over 90% and reduced side effects. However, concerns have arisen that UAE may adversely impact subsequent pregnancies. Data has indicated various obstetrical complications such as recurrent PPH and placenta accreta spectrum (PAS) are more common after UAE.
To determine the association between UAE during first delivery and risks during the second delivery, investigators conducted a nationwide retrospective cohort study. Data was obtained from the Korean National Health Insurance Service (K-NHIS) database, which includes inpatient and outpatient records from the entire South Korean population.
All live births between January 1, 2004, and December 31, 2020, were included in the analysis, with 2004 used as the washout period and 2020 as the follow-up period. Women who underwent hysterectomy during their first delivery were excluded from the analysis.
Women in the UAE group were matched 1:10 to those in the non-UAE group through propensity score matching. Neonatal and long-term outcomes of live births from the second delivery were compared between groups.
Individual-level demographic, diagnosis, and health care utilization data was obtained from the K-NHIS database. Women undergoing UAE during the first delivery were placed in the exposure group, with UAE defined as the presence of the procedure code within 2 weeks after birth.
Maternal outcomes during the second delivery, as well as major congenital malformations, adverse outcomes, and long-term neurodevelopmental outcomes in the second live offspring, were reported as primary outcomes. Maternal outcomes included recurrent PPH, UAE, hysterectomy, maternal intensive care unit (ICU) admission, and Bakri tamponade balloon.
There were 3,616,923 women and their liveborn infants included in the analysis. UAE was reported in 0.12% of women after the first live birth. These women were often older, more often had multiple gestation pregnancies, had a higher prevalence of comorbidities, and more often had a history of abortion and stillbirth than those without UAE.
The rates of second deliveries were 53.1 per 1000-person years for women without UAE vs 39.9 per 1000-person years for women with UAE. The final study cohorts included 11,184 and 1119 of these women, respectively.
The risk of PAS was increased 38.91-fold and the risk of placenta previa 6.98-fold in the UAE group vs the non-UAE group. The UAE group also had a significantly increased risk of preterm birth than the non-UAE group, with an odds ratio (OR) of 2.23.
Additional ORs in the UAE group included 28.82 for receiving a Bakri tamponade balloon, 52.50 for embolization, and 5.31 for hysterectomy. ICU admission and maternal death during the second delivery were also more common in the UAE group.
The risk of major congenital malformations was 4.6% in the non-UAE group and 7.2% in the UAE group, with an OR of 1.62. Neonatal ICU admission was also more common in the UAE group, as well as adverse neonatal events.
These results indicated increased risks of several PPH-associated complications among women who underwent UAE during their first delivery. Investigators recommended further research to understand the mechanisms of these complications for refinement of UAE procedures.
Reference
Yang WJ, Kang D, Sung JH. Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: a nationwide cohort study. Hum Reprod Open. 2024;2024(3):hoae043. doi:10.1093/hropen/hoae043
