Hysterectomy used more for postpartum bleeding compared to l
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Many women suffering significant postpartum bleeding continue to receive hysterectomies, rather than uterine artery embolization (UAE), despite evidence that UAE results in reduced hospital stays and costs, and offers an opportunity to preserve fertility, according to new research to be presented at the Society of Interventional Radiology Annual Scientific Meeting.

This study was purposed to evaluate the utilization and comparative effectiveness of various therapies in patients with clinically significant postpartum hemorrhage (PPH) requiring blood transfusion +/- an invasive procedure.

Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, researchers identified all women with live-birth deliveries who experienced clinically significant PPH (defined as those receiving a blood transfusion only or transfusion plus hysterectomy or uterine artery embolization [UAE]). Univariate analysis chi-square testing was used to determine demographic and clinical predictors of receipt of various therapies. Logistic regression was used to compare mortality and prolonged length of hospital stay for different treatment groups.

Results were;
--Of 9.8 million identified live births, the overall incidence of PPH was 31 per 1,000 live births.

--The most common intervention for PPH was transfusion, at an average incidence of 116.4 per 1000 cases of PPH. The incidence of hysterectomy to treat PPH was significantly greater than the incidence of UAE.

--The following factors predicted the type of therapies received: race, maternal age, year of admission, elderly primigravida, previous or current Cesarean section, the breech position of the fetus, placenta previa, pre-existing hypertension, pre-eclampsia, eclampsia, gestational diabetes, post-date pregnancy, premature rupture of membranes, cervical laceration, uterine rupture, dystocia, forceps delivery, and hemorrhagic shock.

--On logistic regression, the likelihood of mortality from hysterectomy was 3.1 times that of UAE. The prolonged hospital stay was 2.1 times more likely with hysterectomy than UAE.

In conclusion, despite lower mortality and shorter hospital stays, UAE is used far less commonly than hysterectomy in the management of clinically significant PPH.

Abstract: sirmeeting.org
Source: https://www.sirweb.org/media-and-pubs/media/news-release-archive/sir-2021-uae-pph-031621/