The impact of uterine artery embolization to reduce postpartum hysterectomy

Abstract

Uterine artery embolization (UAE) has been part of treatment options for postpartum hemorrhage (PPH) at Oslo University Hospital since 2007. We wanted to investigate if introduction of UAE influenced the incidence of postpartum hysterectomy and in addition to evaluate clinical success and fertility after UAE. This retrospective study includes patients treated for severe PPH undergoing UAE from 2007 to 2010 and patients undergoing hysterectomy in the period before (2003–2006) and after (2007–2010) the introduction of UAE. Hospital records were reviewed. Patients who were embolized were contacted with a questionnaire to evaluate fertility. We observed a decrease in the incidence of postpartum hysterectomy since introduction of UAE for PPH; however, the reduction was not significant (0.40/1000 versus 0.35/1000, p = 0.80). UAE resulted in clinical success in 28 patients (82 %). None were re-embolized. Twenty women were hysterectomized. Five of these patients had preceding embolization, four were hysterectomized due to re-bleeding, and one due to sepsis with suspected uterine necrosis. One patient had a uterine horn removed due to bleeding. Nine women became pregnant after UAE. There were 11 reported pregnancies and 8 live births. PPH re-occurred in 63 % of live births, with median bleeding volume of 700 ml (range 500–1600 ml). Introducing UAE decreased postpartum hysterectomy rate in our department, however not significant. Our success rate of UAE (82 %) is in line with previously published data. UAE may preserve fertility potential. High recurrence rate of PPH after previous UAE was observed.