Obstetric Outcomes of Pregnancy After Uterine Artery Embolization

Figures & data

Table 1 Clinical Characteristics of the Post-UAE and Control Groups

	Post-UAE (n=16)	Non-UAE (n=3139)	P value
Age (years)	35.0 ± 4.3 (27–42)	33.7 ± 5.4 (17–56)	0.34
GW at delivery	38.0 ± 1.9 (27–42)	38.0 ± 2.5 (22–42)	0.99
Maternal BMI	24.4 ± 2.3 (21–29)	24.9 ± 3.6 (16–51)	0.66
Parity	1 ± 0.37 (0–2)	0.58 ± 0.81 (0–8)	0.49
Blood loss (mL) (range)	1397 ± 1175 (180–4000)	779 ± 765 (0–16000)	<0.01
Blood transfusion	12.5% (2/16)	6.4% (202/3139)	0.32
Birth weight (g) (range)	3027 ± 635.6 (1326–4156)	2862 ± 851 (186–4556)	0.24
Previous CD	37.5% (6/16)	12.3% (388/3139)	<0.01
IVF-ET	31.2% (5/16)	13.1% (414/3139)	0.10
Placenta previa	12.5% (2/16)	3.9% (123/3139)	0.07

Notes: Data are presented as n (%) or mean ± standard deviation, unless otherwise specified. Bold indicates statistical significance.

Abbreviations: BMI, body mass index; CD, cesarean delivery; GW, gestational weeks; IVF-ET, in vitro fertilization-embryo transfer; NA, not available; PPH, Postpartum hemorrhage; and UAE, uterine artery embolization.

Table 2 Detailed Patient Information of the Post-UAE Group

Patient No.	Current Pregnancy											Previous Pregnancy
	Age	GP	BMI	Delivery^a	Previous CD	IVF	PP	EBL (mL)	PAS	FGR	PTB	EBL (mL)	Cause of PPH	FGR	PTB
1	37	G2P1	22.5	VD				500				>2000	Unk
2	32	G4P2	21.9	VD				717				2485	RPOC
3	32	G4P1	25.3	VD				340				5000	Atonic
4	30	G2P1	21.4	VD				180				4500	Atonic
5	36	G4P1	27.6	VD				800				4500	Atonic
6	39	G4P1	27.7	CD	Yes			1400				Unk	Atonic
7	35	G3P2	24.6	CD	Yes			1270				2450	MRP
8	41	G2P1	23.1	CD		Yes		500				Unk	Atonic		Yes
9	30	G2P0	21.7	VD		Yes		1000				1000	RPOC^b
10	38	G2P1	23.6	VD		Yes		500				2700	Atonic
11	34	G2P1	26.0	VD				4000	A			Unk	MRP
12	31	G2P1	23.0	CD	Yes			2240	A			3400	LLP
13	42	G4P1	24.0	VD		Yes		4000	A			4000	MRP
14	38	G2P1	24.9	CD	Yes	Yes		1600	A			Unk	Atonic
15	27	G2P1	24.3	CD	Yes		Yes	1280	I		Yes	3200	Atonic	Yes
16	38	G3P2	29.4	CD	Yes		Yes	2040	I	Yes	Yes	Unk	Atonic	Yes

Notes: ^aIndicates mode of delivery. ^bAn abortion case.

Abbreviations: UAE, uterine artery embolization; No., number; BMI, body mass index; CD, cesarean delivery; IVF, in vitro fertilization; PP, placenta previa; EBL, estimated blood loss; PAS, placenta accreta spectrum; FGR, fetal growth restriction; PTB, preterm birth; PPH, postpartum hemorrhage; GP, gravidity and parity; VD, vaginal delivery; Unk, unknown; Atonic, atonic bleeding; MRP, manual removal of placenta; RPOC, retained products of conception; LLP, low-lying placenta; A, placenta accreta; and I, placenta increta.

Table 3 Clinical Outcomes of Subsequent Pregnancies

	Post UAE (n = 16)	Non-UAE (n = 3139)	Odds Ratio	95% CI	P-value
Preterm birth (< 37 weeks)	12.5% (2/16)	14.2% (446/3139)	0.863	0.218–3.414	0.84
SGA <-1.5 SD	6.2% (1/16)	9.9% (313/3139)	0.602	0.104–3.584	0.61
PAS	37.5% (6/16)	1.2% (37/3139)	50.303	17.38–145.592	<0.01

Notes: Data are presented as n (%) unless otherwise specified. Bold indicates statistical significance.

Abbreviations: CI, confidence interval; SGA, small for gestational age; PAS, placenta accreta spectrum; UAE, uterine artery embolization.

Table 4 Comparison of the Rate of Placenta Accreta in Various Patterns of Patient Baseline Characteristics

	Post UAE	Non-UAE	Odds Ratio	95% CI	P value
All patients	37.5% (6/16)	1.1% (37/3139)	50.303	17.38–145.59	<0.01
Excluded PP, p-CD, and IVF	16.6% (1/6)	0.08% (2/2301)	229.9	17.85–2961.50	<0.01
Excluded PP and p-CD	20% (2/10)	0.2% (6/2654)	110.333	19.28–631.32	<0.01
Excluded PP and IVF	22.2% (2/9)	0.2% (7/2622)	106.73	18.78–606.73	<0.01
With IVF, excluded PP and p-CD	25.0% (1/4)	1.1% (4/353)	29.08	2.46–343.31	<0.01
With PP and p-CD, excluded IVF	100% (2/2)	48% (12/25)	5.40	0.24–123.81	0.09

Notes: Bold indicates statistical significance.

Abbreviations: CD, cesarean delivery, CI, confidence interval; IVF, in vitro fertilization-embryo transfer pregnancy; PAS, placenta accreta spectrum, p-CD; previous cesarean delivery; PP, placenta previa; p-UAE, post-UAE; UAE, uterine artery embolization.

Figure 1 Forest plot of odds ratio of placenta accreta spectrum in post-UAE cases. Forest plots show the OR and 95% CI of the risk for PAS. Various combinations were determined, and we revealed that post-UAE is a significant risk factor for PAS except for the P-UAE with PP and p-CD groups. (-) indicates that the patients with pointed factor were excluded. Bold indicates statistical significance.

Abbreviations: CD, cesarean delivery, CI, confidence interval; IVF, in vitro fertilization-embryo transfer pregnancy; PAS, placenta accreta spectrum, p-CD; previous cesarean delivery; PP, placenta previa; p-UAE, post-UAE; UAE, uterine artery embolization.

Table 5 Literature Review on the Rate of Placenta Accreta Spectrum in Subsequent Pregnancies Following Uterine Artery Embolization Due to Postpartum Hemorrhage

Author (Reference)	Year	No.	Cause of Previous PPH	Number of PAS	Subsequent Pregnancy	Treatment for PAS	Diagnosis of PAS
Kitao^Citation11	2009	1	AB	1/1	PPH due to PAS	UAE → hyst	Histopathological
Sentilhes^Citation14	2010	19	Unknown	2/19 (10.5%)	4 cases: AB 2 cases: PAS	1 case: hyst 1 case: UAE	Unknown
Kanter^Citation15	2013	1	AB	1/1	Uterine inversion	1 case: hyst	Histopathological
Inoue^Citation16	2014	30	Unknown	5/30 (16.7%)	7 cases: PPH	5 cases: hyst	Unknown
Poggi^Citation17	2015	17	^a	4/17 (23.5%)	4 cases: PAS	3 cases: hyst	Unknown
Nakamura^Citation18	2016	2	^b	2/2	PPH due to PAS	2 cases: hyst	Histopathological
Jitsumori	2020	16	c	6/16 (37.5%)	6 cases: PAS	6 cases: hyst	Histopathological

Notes: ^a10 cases: AB, 3 cases: Laceration, 2 cases: PAS, 1 case: Abruption, and 1 case: Placenta previa. ^b1 case: Uterine rupture and 1 case: vaginal hematoma. ^c13 cases: AB, 1 case: PPH after abortion, 1 case: Twins, and 1 case: clinical placenta accreta.

Abbreviations: AB, atonic bleeding; No, number; hyst, hysterectomy; PAS, placenta accreta spectrum; PPH, postpartum hemorrhage; UAE, uterine artery embolization.

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