Large Study Shows UAE Is Used Significantly Less Than Hysterectomy to Manage Postpartum Bleeding

March 16, 2021—The Society of Interventional Radiology (SIR) announced findings from a national inpatient sample study of the utilization and comparative effectiveness of hysterectomy versus uterine artery embolization (UAE) for clinically significant postpartum hemorrhage.

The study showed that many women with significant postpartum bleeding continue to receive hysterectomies rather than UAE, despite evidence that UAE results in reduced hospital stays and costs and offers an opportunity to preserve fertility.

The study will be presented at the SIR annual scientific meeting, which will be held virtually on March 20-26, 2021. The study abstract, number 41, can be found online at sirmeeting.org.

Janice M. Newsome, MD, a lead author of the study, commented in SIR’s press release, “Giving birth has become increasingly dangerous for women in the United States, and postpartum hemorrhage is a leading cause of the loss of life related to childbirth. All patients should have consistent access to a treatment that is safer, has an easier recovery, and could preserve their ability to continue to have children.” Dr. Newsome is Associate Professor, Department of Radiology and Imaging Sciences at Emory University School of Medicine in Atlanta, Georgia.

According to SIR, the investigators conducted a review of approximately 10 million hospital births between 2005 and 2017 using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, which tracks every hospital admission in the United States. They examined the results of significant postpartum bleeding, which occurred in 3.1% of live births.

The investigators found that the most common intervention was transfusion. However, removal of the uterus through hysterectomy was used 60% more often to manage bleeding than UAE. Hysterectomy was twice as common as embolization in Hispanic patients and also more common in rural and nonteaching urban hospitals, in the South, and among Medicaid and self-paying patients.

Additionally, the investigators reported that prolonged hospital stays > 14 days were twice as likely in patients who had hysterectomies, and the procedure resulted in $18,000 higher hospital charges.

“Postpartum hemorrhage can occur quickly, and effective treatment options should be readily available to every woman having a child in the United States,” stated Dr. Newsome. “For hospitals that have interventional radiology services available, this can be accomplished by creating a concrete care plan for new mothers who are at higher risk of dangerous bleeding during childbirth.”

The SIR announcement noted that Dr. Newsome envisions creating postpartum hemorrhage response teams, similar to other trauma teams. These response teams would train together and develop response protocols so that they are better able to identify risk factors of postpartum hemorrhage and ensure the right staff are on hand for delivery to respond quickly and save mothers’ lives before it gets to the point of needing radical surgery.