Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: a nationwide cohort study.

IF 8.3 Q1 OBSTETRICS & GYNECOLOGY
Human reproduction open Pub Date : 2024-06-26 eCollection Date: 2024-01-01 DOI:10.1093/hropen/hoae043
Woo Jin Yang, Danbee Kang, Ji-Hee Sung, Myung Gyu Song, Hyejeong Park, Taegyun Park, Juhee Cho, Tae-Seok Seo, Soo-Young Oh
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引用次数: 0

Abstract

Study question: What are the maternal and neonatal outcomes of second delivery in women who underwent uterine artery embolization (UAE) during their first delivery?

Summary answer: Women who underwent UAE during their first delivery exhibited higher risks of placental problems, preterm births, and postpartum hemorrhage (PPH) in second delivery and the second offspring also showed increased risk of major congenital malformations, admission to the neonatal intensive care units (NICU), necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia.

What is known already: UAE is a minimally invasive procedure used as an alternative to hysterectomy for managing severe PPH. However, recent studies have raised concerns about potential obstetric complications, including recurrent PPH, placenta accreta spectrum (PAS), and fetal growth restriction in subsequent delivery following UAE.

Study design size duration: This was a nationwide retrospective cohort study using the Korean National Health Insurance Service (K-NHIS) database, covering 50 million individuals from 2004 to 2020. The cohort included 3 616 923 women with live births between 1 January 2005 and 31 December 2019 with follow-up data extending to 31 December 2020.

Participants/materials setting methods: The study included women who had their first live birth between 2005 and 2019, excluding those who underwent hysterectomy (without UAE = 3 612 389, UAE = 4534). Among them, we selected women who had single gestation secondary delivery (without UAE = 1 694 600, UAE = 1146). Propensity score matching was used to control for confounding factors, resulting in 11 184 women without UAE and 1119 women with UAE for subsequent analysis.

Main results and the role of chance: Women in the UAE group had significantly higher risks of PAS (odds ratio (OR) = 38.91, 95% CI = 18.61-81.34), placenta previa (OR = 6.98, 95% CI = 5.57-8.75), and preterm birth (OR = 2.23, 95% CI = 1.71-2.90) during their second delivery. The risk of recurrent PPH was also significantly higher (OR = 8.94, 95% CI = 7.19-11.12). Their second offspring were more likely to have major congenital malformations (OR = 1.62, 95% CI = 1.25-2.11) and adverse neonatal outcomes, including NICU admissions (OR = 1.83, 95% CI = 1.48-2.25). Long-term outcomes showed a higher risk of attention-deficit/hyperactivity disorder (hazard ratio = 1.64, 95% CI = 1.03-2.63) but were otherwise comparable to those in the without UAE group.

Limitations reasons for caution: Retrospective nature of the study may have introduced exposure and outcome misclassifications, despite the reliability of the K-NHIS database. Unmeasured confounders and selection bias due to only including live births could also have influenced the results.

Wider implications of the findings: Women with a history of UAE require meticulous prenatal care and close monitoring during subsequent deliveries due to increased risks of complications. Counseling and referral to high-risk medical centers may improve outcomes. Further research is needed to understand the mechanisms of complications in both mothers and offspring at sequential delivery, as well as to refine UAE procedures.

Study funding/competing interests: This study supported by Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (HC21C0123). This study was funded by S.-Y.O. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Trial registration number: N/A.

子宫动脉栓塞治疗产后出血与二次分娩对母婴结局的影响:一项全国性队列研究。
研究问题第一次分娩时接受子宫动脉栓塞术(UAE)的妇女第二次分娩时的产妇和新生儿结局如何?第一次分娩时接受子宫动脉栓塞术的妇女在第二次分娩时出现胎盘问题、早产和产后出血(PPH)的风险较高,第二次分娩的后代出现重大先天性畸形、入住新生儿重症监护室(NICU)、坏死性小肠结肠炎、脑室内出血和支气管肺发育不良的风险也较高:UAE是一种微创手术,可替代子宫切除术治疗严重的PPH。然而,最近的研究引起了人们对潜在产科并发症的关注,包括复发性 PPH、胎盘早剥谱系(PAS)和 UAE 之后胎儿生长受限:这是一项利用韩国国民健康保险服务(K-NHIS)数据库进行的全国范围内的回顾性队列研究,从 2004 年至 2020 年覆盖了 5000 万人。队列包括 2005 年 1 月 1 日至 2019 年 12 月 31 日期间的 3 616 923 名活产妇女,随访数据延续至 2020 年 12 月 31 日:研究纳入了 2005 年至 2019 年间首次活产的妇女,不包括那些接受子宫切除术的妇女(无 UAE = 3 612 389,UAE = 4534)。其中,我们选取了单胎二次分娩的妇女(无 UAE = 1 694 600,UAE = 1146)。为了控制混杂因素,我们采用了倾向得分匹配法,最终得出 11 184 名未做过阿联酋分娩的产妇和 1119 名做过阿联酋分娩的产妇,并进行了后续分析:UAE组产妇在第二次分娩时发生PAS(几率比(OR)=38.91,95% CI=18.61-81.34)、前置胎盘(OR=6.98,95% CI=5.57-8.75)和早产(OR=2.23,95% CI=1.71-2.90)的风险明显更高。再次发生 PPH 的风险也明显更高(OR = 8.94,95% CI = 7.19-11.12)。她们的第二个后代更有可能出现重大先天性畸形(OR = 1.62,95% CI = 1.25-2.11)和不良新生儿结局,包括入住新生儿重症监护病房(OR = 1.83,95% CI = 1.48-2.25)。长期结果显示,患注意力缺陷/多动症的风险较高(危险比 = 1.64,95% CI = 1.03-2.63),但在其他方面与无 UAE 组相当:尽管K-NHIS数据库非常可靠,但研究的回顾性可能会导致暴露和结果分类错误。研究结果的广泛意义:研究结果的广泛意义:由于并发症的风险增加,有超生史的妇女需要细致的产前护理,并在随后的分娩过程中进行密切监测。咨询和转诊到高风险医疗中心可能会改善结果。需要进一步开展研究,以了解母亲和后代在连续分娩时出现并发症的机制,并完善 UAE 程序:本研究由大韩民国保健福祉部(HC21C0123)资助的以患者为中心的临床研究协调中心(PACEN)支持。本手稿的作者声明与任何其产品或服务可能与文章主题相关的公司没有任何关系:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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