Korea University study reveals potential effects of uterine artery embolization on subsequent deliveries

Postpartum hemorrhage (PPH) is a serious condition where a woman experiences significant blood loss after giving birth. It affects about 4–6% of new mothers and can lead to severe complications if not managed properly. Traditional treatments for PPH include medications to contract the uterus, physical compression, and using a balloon device inside the uterus to stop the bleeding. When these methods don’t work, doctors might perform a procedure called UAE. UAE is a less invasive alternative to surgery that involves blocking the blood vessels to stop the bleeding. However, recent studies have raised concerns about the potential effects of UAE on subsequent deliveries, prompting further investigation.

To further investigate this, a group of researchers led by Professor Woo Jin Yang from Korea University College of Medicine, conducted a study using data from the Korean National Health Insurance Service database. After accounting for other factors that might influence the outcomes, the researchers compared women who had UAE during their first delivery with those who did not undergo the procedure. Their study was published in Volume 2024, Issue 3, of the journal Human Reproduction Open on 26 June 2024.

“Notably, our findings showed that women who had UAE during their first delivery were more likely to face complications in their next pregnancy. These complications included higher risks of placental problems, such as the placenta attaching too deeply or being positioned abnormally. These women were  more likely to have premature births and severe bleeding again during their second delivery,” explains Prof. Yang.

In addition, the babies born to women who had undergone UAE were found to have a higher chance of major birth defects, especially heart problems, and often needed special care in a neonatal intensive care unit. Although most long-term health issues were not more common, there was a slightly higher risk of attention-deficit/hyperactivity disorder (ADHD) in these children. However, the finding regarding ADHD in particular requires careful interpretation. Further research with larger sample sizes and longer follow-up periods is needed to confirm and understand the potential link between UAE and ADHD in children.

The findings of this study could help doctors have better conversations with the women undergoing UAE, helping them prepare for a safer pregnancy and delivery. Women who have had UAE might also benefit from personalized prenatal care that addresses their specific needs, giving them more confidence and a proactive approach to their pregnancy. This might be in the form of more regular check-ups and special monitoring of the baby.

Hospitals can use this information to improve their delivery plans for women with a history of UAE, ensuring that they are well-prepared and receive individualized care. Additionally, pediatric teams can work closely with obstetricians to ensure that newborns receive the best possible care. Moreover, the guidelines for caring for these pregnancies might be updated to reflect these findings, leading to better care practices.

"The primary aim of our study is to promote safer childbirth experiences for women with a history of UAE, not to discourage or alarm them about subsequent pregnancies. By identifying potential risks, we seek to improve care strategies, ultimately supporting these women in achieving healthy pregnancies and deliveries," concludes Prof. Yang.

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Reference                                    

Title of original paper: Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: A nationwide cohort study

Journal: Human Reproduction Open

DOI: https://doi.org/10.1093/hropen/hoae043 

About the institute

Korea University College of Medicine is the medical school of Korea University. It is located in Seoul, South Korea. As one of the oldest medical schools in South Korea, it has been historically regarded as one of the country's top medical schools. The school was founded as Chosun Women's Medical Training Institute in 1928 by Rosetta Sherwood Hall. The institute was subsequently renamed several times and ultimately merged with Korea University to become Korea University College of Medicine. So far, the school has produced over 7,000 graduates, most of whom are working as prominent physicians and public health advocates worldwide.

Website: https://medicine.korea.ac.kr/en/index.do

About the authors

This study represents a collaborative effort led by experts in various fields. Dr. Woo Jin Yang and Dr. Tae-Seok Seo, interventional radiologists, bring their expertise in uterine artery embolization (UAE) procedures. Dr. Danbee Kang, a specialist in clinical research design and methodology, ensures the study's rigorous analytical approach. Dr. Soo-Young Oh, a renowned obstetrician, provides critical insights into high-risk pregnancies and maternal-fetal health. This interdisciplinary team combines clinical experience with research expertise to investigate the long-term impacts of UAE on subsequent pregnancies and offspring health.