February 17, 2022

Saving Women’s Lives with a Minimally Invasive Treatment

Guest blog by Janice M. Newsome, MD, FSIR, interventional radiologist and associate professor, Department of Radiology and Imaging Sciences at Emory University School of Medicine 

The last thing a woman or her partner wants to consider when entering the labor and delivery ward of a hospital is whether something could go wrong; but the unfortunate reality is that many women will experience difficulties during delivery. One of the more common issues is postpartum hemorrhage, a serious complication in childbirth that causes heavy bleeding. Postpartum hemorrhage is the leading cause of childbirth-related mortality in the United States, and because it can occur unexpectedly and threaten the life of the mother, treatment options are limited.

Many physicians, forced to act quickly, will perform a hysterectomy. However, there is a safer and less-invasive option that interventional radiologists can provide quickly, safely, and more economically. It’s called uterine artery embolization (UAE).

 Two Life-Saving Treatments

Approximately 3% of women experience significant postpartum hemorrhage, and many of them had no risk factors. Postpartum hemorrhage can occur suddenly with no warning signs, making it difficult for physicians to prepare a response. Currently, the most common treatment is through transfusion. But, if the bleeding is severe, physicians will often remove the mother’s uterus through a hysterectomy.

Hysterectomies are costly, require more recovery time in the hospital, and take away the patient’s ability to have children in the future. Such an extreme procedure may not be necessary for all patients, and many women are unaware that there is an alternative solution.

UAE is a minimally invasive procedure performed by an interventional radiologist using real-time imaging to inject tiny particles into uterine arteries to control the bleeding. Evidence has shown that in addition to possibly preserving fertility, UAE is safe and has a faster, easier recovery process. It is also considerably less costly.

The Difference in the Numbers

To fully understand how postpartum hemorrhage is treated, my colleagues and I examined data from the Healthcare Cost and Utilization Project’s National Inpatient Sample database. We reviewed nearly 10 million births between 2005 and 2017, finding that hysterectomy was used 60% more often than UAE. Hysterectomy was more common among Hispanic patients, in rural and non-teaching urban hospitals in the South, and among Medicaid and self-paying patients. Patients receiving hysterectomies were twice as likely as UAE patients to require prolonged hospital stays of more than 14 days and paid an average of $18,000 more in hospital charges.

What We Can Do to Change This

Postpartum hemorrhage can occur quickly, and effective treatment options like UAE should be readily available to every woman. Hysterectomies are often the only choice, but not always. Unfortunately, UAE is often not considered until it is too late, so it is important that this treatment option is made top-of-mind before an emergency occurs. While UAE can be a lifesaving procedure, it can only be performed if an interventional radiologist is available.

Patients found to be at risk of dangerous bleeding during childbirth should ask their physicians about having an interventional radiologist available during delivery so they are able to respond quickly if something occurs. Hospitals could also help expand the options for women by creating postpartum hemorrhage response teams, similar to other trauma teams, that include an interventional radiologist. The team would train together and develop response protocols to better identify risk factors in mothers. This process would ensure that proper staff is on hand for delivery to be able to respond quickly and save mothers’ lives before radical surgery is needed.

For more information, visit Society of Interventional Radiology’s (SIR) Patient Center.