By Alan Mozes
HealthDay reporter
WEDNESDAY, March 24, 2021 (HealthDay News) – Profuse postpartum bleeding can endanger the mother’s life, and doctors sometimes turn to a hysterectomy to stop the bleeding. However, a new study suggests that a less invasive, underutilized procedure might be a better, less drastic option.
Researchers found that hysterectomies – the removal of the uterus – are 60% more common in postpartum bleeding than uterine artery embolization (UAE) procedures, although “UAE is safer and easier to recover than hysterectomy,” study author Dr. Janice Newsome, Associate Professor in the Department of Radiology and Imaging at Emory University’s School of Medicine in Atlanta.
Newsome recently spoke at the Society of Interventional Radiology’s annual virtual meeting that serious postpartum bleeding can occur quickly and is not uncommon. It affects approximately 100,000 American women each year and is the leading cause of maternal mortality worldwide, she said.
Complicating the situation is the fact that up to 20% of the time there are no obvious risk factors that doctors would warn in advance, Newsome added.
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The most common intervention is a blood transfusion. After reviewing data on nearly 10 million U.S. births between 2005 and 2017, her team concluded that hysterectomy is the second most common treatment. In comparison, the UAE is an “underutilized option,” she noted.
According to the US National Library of Medicine, sedation in the UAE is performed with a localized pain reliever followed by a thin tube (catheter) inserted through the groin and into the uterine artery. Tiny particles of gelatin are then inserted through the tube to contain the blood supply and stop the bleeding.
Fewer patients received UAE
The Newsome team calculated that for every 1,000 bleeds after birth, blood transfusions were administered at the rate of approximately 116 patients. Hysterectomies were performed at the rate of approximately 20 patients per 1,000 cases. In comparison, the UAE was the method of choice with approximately 13 patients per 1,000 bleeding cases.
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This happened despite the fact that a hysterectomy is permanent, after which the patient can no longer have children. “Patients with hysterectomies were twice as likely to be hospitalized for longer than 14 days” compared to patients in the UAE. Hysterectomy patients also experience significantly higher hospital bills, averaging $ 18,000 more per patient, according to Newsome’s team.
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The study also found that hysterectomies were twice as common in Hispanic women as they were in the UAE. They were also more common among Medicaid patients, uninsured patients, and those living in rural communities.
Newsome suggested that future hospitals should ensure that an interventional radiologist is available to improve their ability to care for the UAE in the event of a postpartum bleeding emergency.
Results presented at medical sessions are deemed preliminary until published in a peer-reviewed journal.
Studies can leave unanswered questions
Dr. Eran Bornstein, vice chairman of obstetrics and director of material fetal medicine at Lenox Hill Hospital in New York City, argues that choosing a treatment for postpartum bleeding is far more complex than the study suggests.
“This is important work that is on a very important topic,” noted Bornstein, who was not part of the study. “And the results have some validity to show that in some places in the US there may be a problem with adequate access to interventional radiology. But I would interpret the results cautiously.”
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For one thing, Bornstein said, it could very well be that the lower mortality and shorter hospital stays that the study links to the UAE simply mean that UAE patients had less bleeding.
Another problem: “The data used in this study look at procedural codes in a large population” to calculate the frequency of treatment use. “But they don’t look at cases in detail” and take into account all the different factors that can cause maternal bleeding. “And not all of these conditions are treated equally,” he said.
Additionally, the study essentially focuses on just two treatments, “while the truth is, there are many,” added Bornstein.
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“There are pharmacological: drugs to try to contract the uterus. There are manual massages, which can sometimes be effective. There are cut repairs. There are several ways to cause tamponades [closure] in the womb. Then there are surgical techniques using different types of stitches to compress the uterus. And then, yes, there is embolization and hysterectomy, “admitted Bornstein.
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“And of course a hysterectomy is the last result,” he said. “I don’t sponsor a hysterectomy. But I don’t know of any obstetrician who would want to do a postpartum hysterectomy when they don’t feel it is necessary. The fact is, embolization (UAE) is a great add-on option. But a hysterectomy can be life-saving Procedures for the major postpartum hemorrhages. You just can’t generalize. You have to look at each case individually. “
More information
For more information on the UAE, please visit the Cleveland Clinic.
SOURCES: Dr. Janice Newsome, Associate Professor, Department of Radiology and Imaging, Medical School, Emory University, Atlanta; Eran Bornstein, MD, vice chairman of obstetrics and director of maternal fetal medicine at Lenox Hill Hospital and associate professor at the Zucker School of Medicine at Hofstra University / Northwell, New York City; Society for Interventional Radiology, virtual annual meeting, 20.-26. March 2021
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