Risk Factors Preceding Uterine Artery Embolization in the Setting of Postpartum Hemorrhage

Purpose Uterine artery embolization (UAE) is a minimally invasive, uterine-sparing intervention that can help control postpartum hemorrhage (PPH) when more conservative management has failed. While risk factors for PPH are well established, those leading to the use of embolization remain unclear. This study aimed to determine how maternal history, pregnancy characteristics, and peripartum events impact the utilization of UAE for PPH in the peripartum period. Materials and Methods This case-control study queried electronic health records from 78 healthcare organizations in the United States for patients with PPH from April 2014 to April 2024. Patients who did and did not undergo UAE were then analyzed for risk factors in the preceding year from their initial event. Results Among 158,741 patients with PPH, 796 underwent UAE (mean age 32.1 ± 6.4 years). Significant risk factors included uterine scar (AR 57.20%), fibroids (AR 57.86%), endometriosis (AR 45.79%), advanced maternal age (AR 43.74%), assisted reproductive technology (AR 59.52%), uterine overdistension (AR 29.17%), placental abnormalities (AR 59.66%), pre-eclampsia (AR 37.56%), cesarean delivery (AR 55.81%), anemia (AR 76.62%), disseminated intravascular coagulation (AR 93.21%), thrombocytopenia (AR 57.39%), and shock (AR 94.46%) (p < 0.05). Other identified factors did not significantly impact UAE use. Conclusion Identifying these critical risk factors can help preemptively identify patients at higher risk of needing UAE and can be used to improve multidisciplinary coordination of care and response times, potentially reducing maternal and neonatal morbidity and mortality.