Use of Uterine Tamponade and Interventional Radiology Procedures During Delivery Hospitalizations

Abstract

Objective: To characterize use of uterine tamponade and interventional radiology procedures.

Methods: This retrospective study analyzed uterine tamponade and interventional radiology procedures in a large administrative database. The primary outcomes were temporal trends in these procedures 1) during deliveries, 2) by hospital volume, and 3) before hysterectomy for uterine atony or delayed postpartum hemorrhage. Three 3-year periods were analyzed: 2006-2008, 2009-2011, and 2012-2014. Risk of morbidity in the setting of hysterectomy with uterine tamponade and interventional radiology procedures as the primary exposures was additionally analyzed in adjusted models.

Results: The study included 5,383,486 deliveries, which involved 6,675 uterine tamponade procedures, 1,199 interventional radiology procedures, and 1,937 hysterectomies. Interventional radiology procedures increased from 16.4 to 25.7 per 100,000 delivery hospitalizations from 2006-2008 to 2012-2014 (P<.01), and uterine tamponade increased from 86.3 to 158.1 (P<.01). Interventional radiology procedures use was highest (45.0/100,000 deliveries, 95% CI 41.0-48.9) in the highest and lowest (8.9/100,000, 95% CI 7.1-10.7) in the lowest volume quintile. Uterine tamponade procedures were most common in the fourth (209.8/100,000, 95% CI 201.1-218.5) and lowest in the third quintile (59.8/100,000, 95% CI 55.1-64.4). Interventional radiology procedures occurred before 3.3% of hysterectomies from 2006 to 2008 compared with 6.3% from 2012 to 2014 (P<.05), and uterine tamponade procedures increased from 3.6% to 20.1% (P<.01). Adjusted risks for morbidity in the setting of uterine tamponade and interventional radiology before hysterectomy were significantly higher (adjusted risk ratio [aRR] 1.63, 95% CI 1.47-1.81 and aRR 1.75 95% CI 1.51-2.03, respectively) compared with when these procedures were not performed.

Conclusion: This analysis found that uterine tamponade and interventional radiology procedures became increasingly common over the study period, are used across obstetric volume settings, and in the setting of hysterectomy may be associated with increased risk of morbidity, although this relationship is not necessarily causal.

Figure 1.

Temporal trends in uterine tamponade and embolization per 100,000 deliveries (A), per 100,000 vaginal deliveries (B), per 100,000 primary cesarean deliveries (C), and per 100,000 repeat cesarean deliveries (D) from 2006 through 2014. Trends for both interventions were statistically significant for all three types of delivery (P<.05). Error bars represent 95% CIs.

Figure 2:

Likelihoods of interventional radiology (A) and uterine tamponade (B) procedures by hospital volume quintile. Each quintile accounts for approximately 20% of overall deliveries, with the first quintile composed of the lowest volume hospitals and the fifth quintiles composed of the highest volume hospitals (P<.01 for comparisons across both groups). Error bars represent 95% CI.

Figure 3.

Temporal trends proportion of patients receiving uterine tamponade and embolization before peripartum hysterectomy for atony or delayed postpartum hemorrhage. These temporal trends were significant (P<.05).

Figure 4.

Proportion of patients receiving uterine tamponade and embolization before peripartum hysterectomy for atony by hospital volume quintile. Each quintile accounts for approximately 20% of overall deliveries, with the first quintile composed of the lowest volume hospitals and the fifth quintiles composed of the highest volume hospitals. Comparisons for both groups by hospital volume quintile were statistically significant (P<.01 for both groups).