Cheaper imaging-guided alternative used far less frequently than hysterectomy for postpartum bleeding

Providers are using hysterectomy far more frequently than the less costly imaging-guided alternative for postpartum bleeding, according to research presented at the Society of Interventional Radiology Annual Scientific Meeting on Wednesday.

Uterine artery embolization has been shown to reduce hospital stays and costs while also potentially preserving fertility. Yet, based on a review of almost 10 million hospital births between 2005-2017, removal of the uterus via hysterectomy was used 60% more often to manage bleeding than embolization. Prolonged hospital stays of two weeks or more were twice as likely among patients who had their uterus removed, and such procedures resulted in $18,000 more in hospital charges on average.

“Giving birth has become increasingly dangerous for women in the U.S., and postpartum hemorrhage is a leading cause of the loss of life related to childbirth," lead author Janice Newsome, MD, an associate professor of radiology with Emory University, said March 24. “All patients should have consistent access to a treatment that is safer, has an easier recovery and could preserve their ability to continue to have children.”

Performed by interventional rads, UAE utilizes real-time imaging to insert a catheter that releases particles into the uterine arteries to help stem bleeding. Despite its minimally invasive nature, hysterectomy was twice as common among Latina patients while also more prevalent at rural and nonteaching hospitals, Newsome and colleagues found. Same for institutions located in the South and among patients on Medicaid or without insurance, they also noted.

To reach their conclusions, Newsome and colleagues tapped the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, which tracks hospital admissions. They estimated that significant postpartum bleeding occurs in about 3.1% of live births in the U.S.