Efficacy and Safety of Uterine Artery Embolisation for Postpartum Haemorrhage: A Systematic Review and Meta-analysis

Abstract

Introduction: Postpartum Haemorrhage (PPH) is one of the main causes of maternal morbidity and mortality globally, accounting for about 25% of maternal deaths. Uterine Artery Embolisation (UAE) has gained recognition as a valuable non surgical treatment option for managing PPH, providing effective haemorrhage control while maintaining fertility. Aim: To assess the effectiveness and safety of UAE in the treatment of PPH. Materials and Methods: A thorough investigation was performed using PubMed, Scopus, Science Direct and the Cochrane Library to locate studies released between 2000 and 2024. The included studies comprised Randomised Controlled Trials (RCTs), case-control studies, and cohort studies that assessed the efficacy of UAE for PPH. The primary outcomes assessed were clinical success rates, technical success rates, and complication rates. Secondary outcomes included fertility preservation, postpartum recovery time, and the impact on future pregnancies. Data analysis was undertaken using Review Manager 5.3, with Mean Differences (MD) and Risk Ratios (RR) calculated for continuous and dichotomous outcomes, respectively. Results: Out of 437 identified studies, 13 met the inclusion criteria for evaluating the effectiveness of UAE as a treatment for PPH. These comprised five RCTs with 1,200 participants, four case-control studies with 800 participants, and four cohort studies with 1,000 participants. The RCTs were conducted in North America, Europe, and Asia, involving women who had experienced PPH. Case-control studies compared UAE recipients to those receiving alternative treatments, considering factors like age, severity of PPH, and obstetric history. Cohort studies followed UAE recipients over time to assess long-term outcomes. The pooled technical success rate was 96% (95% CI, 94.0-98.0; I2=20.0%; p-value=0.143), and the clinical success rate was 92% (95% CI, 88.0-96.0; I2=35.6%; p-value=0.012). The complication rate was 8% (95% CI, 5.0-11.0; I2=40.1%; p-value=0.021). These findings indicate a high effectiveness and reliability of UAE for PPH treatment. The diverse study types and participant populations enhance the generalisability of these results, underscoring UAE’s potential to improve outcomes for women experiencing PPH globally. Conclusion: UAE demonstrates high clinical and technical success rates with a relatively low complication rate, establishing it as a safe and effective intervention for PPH. Future studies need to look into lasting outcomes, including fertility preservation and impacts on subsequent pregnancies, to further substantiate UAE’s role in PPH management.

Keywords

• clinical success
• complication rates
• fertility preservation
• technical success