Effect of pelvic artery embolization for postpartum hemorrhage on subsequent pregnancies: a single-center retrospective cohort study

Figures & data

Figure 1. Flow chart of study. SNUBH: Seoul National University Bundang Hospital; PPH: postpartum hemorrhage; PAE: pelvic artery embolization.

Table 1. Baseline characteristics of the study population according to the exposure to pelvic artery embolization at the previous pregnancy complicated with postpartum hemorrhage.

	Exposure to PAE for previous PPH		p-Value
	Absent (n = 21)	Present (n = 41)
Previous PPH
Age (years)	30.0 (28.5–32.0)	32.0 (30.0–34.0)	0.013
Nulliparous	95.2% (20/21)	87.8% (36/41)	0.654
Gestational age at delivery (weeks)	40.0 (39.1–40.4)	39.3 (38.4–40.2)	0.356
… Preterm birth (<37 weeks)	4.8% (1/21)	0% (0/41)	0.339
Cesarean section	33.3% (7/21)	22.0% (9/41)	0.369
ICU admission	47.6% (10/21)	73.2% (30/41)	0.056
pRBC transfusion	61.9% (13/21)	85.4% (35/41)	0.054
… Units of pRBC	3 (0–5)	7 (3–12)	0.003
… Massive transfusion ≥ 10	9.5% (2/21)	29.3% (12/41)	0.111
Current (subsequent) pregnancy
Age (years)	33.0 (31.0–34.5)	35.0 (33.0–37.0)	0.008
Interval year between delivery	3.0 (2.0–3.5)	3.0 (2.0–3.0)	0.497
Gestational age at delivery (weeks)	38.6 (38.0–39.6)	37.9 (35.6–38.7)	0.082
… Preterm birth (<37 weeks)	19.0% (4/21)	34.1% (14/41)	0.252
Cesarean section	42.9% (9/21)	51.2% (21/41)	0.598
Hb before delivery	11.9 (11.1–13.0)	11.8 (11.3–12.6)	0.935
Hct before delivery	36.1 (33.1–38.1)	35.8 (34.4–37.6)	0.970
Pregnancy-induced hypertension	0% (0/21)	4.9% (2/41)	0.545
GDM	23.8% (5/21)	4.9% (2/41)	0.039
Pregestational DM	0% (0/21)	0% (0/41)	.

PAE: pelvic artery embolization; PPH: postpartum hemorrhage; RBC: red blood cell; Hb: hemoglobin; Hct: hematocrit; GDM: gestational diabetes mellitus; DM: diabetes mellitus. Values are described in median (interquartile range) and percent (n/N).

Table 2. Obstetric and neonatal outcomes compared between the group with pelvic embolization for the previous pregnancy and the group without.

	Exposure to PAE for previous PPH		p-Value
	Absent (n = 21)	Present (n = 41)
Obstetric outcomes
Hospital stay (days)	4.0 (3.0–6.0)	5.0 (3.0–6.0)	0.125
ICU admission	4.8% (1/21)	17.1% (7/41)	0.247
Estimated Blood Loss	300 (100–550)	600 (300–1420)	0.008
Highest Pulse Rate	94 (84–107)	98 (91–112)	0.287
… Tachycardia ≥ 100	38.1% (8/21)	43.9% (18/41)	0.788
Placenta previa	4.8% (1/21)	24.4% (10/41)	0.080
Uterine rupture	0% (0/21)	2.4% (1/41)	>0.999
Placenta accreta spectrum	0% (0/21)	14.6% (6/41)	0.088
Hb after delivery	11.8 (10.0–12.4)	10.4 (8.7–11.4)	0.010
Hct after delivery	34.2 (30.7–37.6)	31.6 (26.3–34.4)	0.010
pRBC transfusion	9.5% (2/21)	34.1% (14/41)	0.063
… Units of pRBC	0 (0–0)	0 (0–3)	0.030
… Massive transfusion ≥ 10	0% (0/21)	2.4% (1/21)	>0.999
Intrauterine balloon tamponade	4.8% (1/21)	4.9% (2/41)	>0.999
PAE	4.8% (1/21)	12.2% (5/41)	0.654
Peripartum hysterectomy	0% (0/21)	14.6% (6/41)	0.088
Neonatal outcomes
Birthweight (grams)	3138 (2881–3309)	2970 (2290–3358)	0.234
1 min Apgar score < 7	19.0% (4/21)	14.6% (6/41)	0.722
5 min Apgar score < 7	4.8% (1/21)	7.3% (3/41)	>0.999
NICU admission	9.5% (2/21)	24.4% (10/41)	0.195

PAE: pelvic artery embolization; PPH: postpartum hemorrhage; ICU: intensive care unit; Hb: hemoglobin; Hct: hematocrit; RBC: red blood cell; NICU: neonatal intensive care unit. Values are described in median (interquartile range) and percent (n/N).

Table 3. Obstetric outcomes compared between the group with cesarean section and the group with vaginal delivery for this pregnancy among those who had undergone pelvic artery embolization.

	Present delivery mode		p-Value
	VD (n = 20)	CS (n = 21)
Age (years)	34.0 (33.0–36.0)	35.0 (33.5–37.0)	0.202
Gestational age at delivery (weeks)	38.7 (36.9–40.4)	37.0 (33.3–38.1)	0.003
… Preterm birth (<37 weeks)	25.0% (5/20)	42.9% (9/21)	0.326
Hb before delivery	12.0 (11.3–12.7)	11.7 (11.1–12.6)	0.705
Hct before delivery	35.8 (34.9–37.7)	35.6 (33.6–37.6)	0.419
Hospital stay (days)	3.0 (3.0–4.0)	6.0 (6.0–9.0)	<0.001
ICU admission	5.0% (1/20)	28.6% (6/21)	0.093
Estimated blood loss	300 (200–388)	1153 (600–2620)	<0.001
Highest Pulse Rate	94 (86–99)	107 (95–123)	0.007
… Tachycardia ≥ 100	20.0% (4/20)	66.7% (14/21)	0.004
Placenta previa	5.0% (1/20)	42.9% (9/21)	0.009
Uterine rupture	0% (0/20)	4.8% (1/21)	>0.999
Placenta accreta spectrum	5.6% (1/21)	23.8% (5/21)	0.184
Hb after delivery	11.0 (9.9–11.6)	9.1 (7.7–11.1)	0.018
Hct after delivery	32.3 (30.6–34.9)	27.4 (23.4–33.4)	0.027
pRBC transfusion	15.0% (3/20)	52.4% (11/21)	0.020
… Units of pRBC	0 (0–0)	1 (0–8)	0.006
… Massive transfusion ≥ 10	0% (0/20)	4.8% (1/21)	>0.999
Intrauterine balloon tamponade	0% (0/20)	9.5% (2/21)	0.488
PAE	5.0% (1/20)	19.0% (4/21)	0.343
Peripartum hysterectomy	0% (0/20)	28.6% (6/21)	0.021

VD: vaginal delivery; CS: cesarean section; ICU: intensive care unit; Hb: hemoglobin; Hct: hematocrit; RBC: red blood cell; PAE: pelvic artery embolization. Values are described in median (interquartile range) and percent (n/N).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, JYP. The data are not publicly available due to their containing information that could compromise the privacy of research participants.