By Dr. Alda L. Tam
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and America is not immune.
A new report from the CDC shows that in 2021, the U.S. suffered one of the worst rates of maternal mortality in history, with mortality rates for Black women significantly higher than for White and Hispanic women.
It’s a scary scenario for any clinician—or mother—and it can happen unexpectedly. In fact, 20% of new mothers have no risk factors. While transfusion remains the first-line treatment, many women are forced to undergo hysterectomies when serious bleeding requires additional therapy.
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Less-invasive treatment is available through the process of uterine artery embolization (UAE). Through UAE, an interventional radiologist uses real-time imaging to release tiny particles into uterine arteries to reduce bleeding. Evidence has shown that in addition to possibly preserving the mother’s ability to have children, UAE is safer and has an easier, faster recovery than a hysterectomy, which offers no chance of maintaining fertility. Unfortunately, UAE remains underutilized compared to hysterectomy for severe PPH.
In a review of nearly 10 million hospital births between 2005 and 2017, researchers found the most common intervention was transfusion, but hysterectomies were 60% more common than UAE. Hysterectomies also resulted in doubling the rate of prolonged hospital stays of more than 14 days, and also added an average cost of $18,000 in hospital charges, compared to UAE.
Persistent systemic problems have created this maternal health crisis in the wealthiest nation in the world, and healthcare leaders have many ways to address this—starting with the healthcare workforce. IRs are available as partners to OB/GYNs to help get patients the care they need. Creating multidisciplinary postpartum hemorrhage-response teams, similar to existing trauma teams, would allow these specialties to train together and develop response protocols to make them better able to identify risk factors of PPH and ensure the right staff are on hand for delivery to save mothers’ lives before the need for radical surgery arises.
Interventional radiologists are a valuable asset
IRs are already complementary partners to OB/GYNs and diagnose and treat a variety of outpatient women’s health conditions, including uterine fibroids, infertility, chronic pelvic pain, and other pelvic floor disorders. A natural extension of this partnership could involve IR playing a larger role in addressing the maternal health crisis which would help patients get the care they need.