Postpartum bleeding does not mean hysterectomy
WEDNESDAY, March 21, 2021 (HealthDay News) – Severe postpartum bleeding can threaten a mother’s life and sometimes doctors turn it into a hysterectomy to end the bleeding. A new study suggests that a less invasive and underused procedure may be a better and less rigorous option.
The researchers determined when postpartum bleeding hysterectomies – removal of the uterus – 60% more common than uterine artery embolization (BAC) procedures, hysterectomy“said Dr. Janice Newsome, an associate professor in the department of radiology and imaging at Emory University School of Medicine in Atlantic.
Speaking recently at the Society of Interventional Radiology’s annual virtual meeting, Newsome noted that severe postpartum bleeding can quickly and uncommonly occur. It affects approximately 100,000 American women each year and is the leading cause of the overall maternal death rate, she said.
The situation is complicated, with up to 20% of cases where there are no significant risk factors that doctors would have warned in advance, Newsom added.
The most common intervention, he noted blood transfusion. After analyzing data from nearly 10 million births in the U.S. from 2005 to 2017, his team concluded that hysterectomy is the second most widely used treatment. In comparison, he pointed out that the Basque Country is a “little-used option”.
According to the US National Library of Medicine, a BAC involves sedation with localized analgesia, followed by the insertion of a thin tube (catheter) into the fish and into the uterine artery. Small gelatin particles enter the tube to stop the blood supply and stop the bleeding.
Fewer patients received the BAC
Newsome’s team estimated that about 116 patients received blood transfusions for 1,000 cases of postpartum hemorrhage per case. Hysterectomies were performed at the rate of approximately 20 patients per 1,000 cases. By comparison, the BAC was the chosen procedure in approximately 13 patients with bleeding per 1,000 cases.
Although this was a permanent hysterectomy, then the patient could not have more children. Also, “long hospital stays of more than 14 days were double the number of patients with hysterectomies,” compared to patients in the BAC. Hysterectomy patients also reported significantly higher hospital bills, the Newsome group reported, averaging $ 18,000 more per patient.
Research has also found that hysterectomies are twice as common among Hispanic women as those in the Basque Country. They were also more common among Medicaid patients, the uninsured, and those living in rural communities.
Newsome suggested that in the future, hospitals should have a radiologist on hand to recover their ability to deliver the BAC in the event of a postpartum hemorrhage emergency.
Findings presented at medical meetings are considered preliminary until they are published in a peer-reviewed journal.
The research may leave unanswered questions
Dr. Eran Bornstein, vice president of obstetrics and director of fetal medicine material at Lenox Hill Hospital in New York, has argued that choosing postpartum bleeding treatment is far more complex than the research suggested.
“It’s an important piece of work that addresses a very important issue,” Bornstein, who was not part of the investigation, said. “And the results have some validity to show that there may be a problem with access to radiology to intervene in some parts of the US. But I would be cautious in interpreting the results.”
On the one hand, Bornstein said, it could very well be that low-death and shorter-hospital deaths are more likely to be linked to examinations in the Basque Country, simply because patients in the Basque Country are more likely to have severe bleeding.
Another problem: “The data used in this study analyze large population procedure codes” to calculate the frequency of treatment use. “But they don’t look at the cases in detail,” and they take into account the different factors that can cause maternal bleeding. “And not all of these conditions are treated equally,” he said.
In addition, the research basically focuses on only two treatments, “although there are actually many,” Bornstein added.
“There is a pharmacological: medication to try to shrink the uterus. There is a manual massage, which can sometimes be effective. Tears are repaired. There are different ways to cause a tampon [closure] in the uterus. Then there are surgical techniques, with different types of points for compressing the uterus. And then, yes, there is embolization and hysterectomy, ”Bornstein admits.
“And, of course, the hysterectomy is the end result,” he stressed. “I’m not promoting hysterectomy. But I don’t know if an obstetrician would want to have a postpartum hysterectomy unless they feel the need. In fact, embolization (UAE) is an additional option. But having a hysterectomy is a life-saving procedure for most significant postpartum hemorrhage. you have to look at each one individually. “
There is more information in the Basque Country Cleveland Clinic.
SOURCES: Janice Newsome, MD, associate professor, department of radiology and imaging, medical school, Emory University, Atlanta; Eran Bornstein, MD, vice president of obstetrics and maternal fetal medicine, Lenox Hill Hospital and director, Zucker School of Medicine, Hofstra University / Northwell, New York; Society of Interventional Radiology, annual virtual meeting, March 20-26, 2021