{
    "abstract": "What are the maternal and neonatal outcomes of second delivery in women who underwent uterine artery embolization (UAE) during their first delivery?\nWomen 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.\nUAE 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.\nThis 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\u00a0616\u00a0923 women with live births between 1 January 2005 and 31 December 2019 with follow-up data extending to 31 December 2020.\nThe study included women who had their first live birth between 2005 and 2019, excluding those who underwent hysterectomy (without UAE\u2009=\u20093\u00a0612\u00a0389, UAE\u2009=\u20094534). Among them, we selected women who had single gestation secondary delivery (without UAE\u2009=\u20091\u00a0694\u00a0600, UAE\u2009=\u20091146). Propensity score matching was used to control for confounding factors, resulting in 11\u00a0184 women without UAE and 1119 women with UAE for subsequent analysis.\nWomen in the UAE group had significantly higher risks of PAS (odds ratio (OR)\u2009=\u200938.91, 95% CI\u2009=\u200918.61-81.34), placenta previa (OR\u2009=\u20096.98, 95% CI\u2009=\u20095.57-8.75), and preterm birth (OR\u2009=\u20092.23, 95% CI\u2009=\u20091.71-2.90) during their second delivery. The risk of recurrent PPH was also significantly higher (OR\u2009=\u20098.94, 95% CI\u2009=\u20097.19-11.12). Their second offspring were more likely to have major congenital malformations (OR\u2009=\u20091.62, 95% CI\u2009=\u20091.25-2.11) and adverse neonatal outcomes, including NICU admissions (OR\u2009=\u20091.83, 95% CI\u2009=\u20091.48-2.25). Long-term outcomes showed a higher risk of attention-deficit/hyperactivity disorder (hazard ratio\u2009=\u20091.64, 95% CI\u2009=\u20091.03-2.63) but were otherwise comparable to those in the without UAE group.\nRetrospective 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.\nWomen 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.\nThis 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.\nN/A.",
    "authors": [
        {
            "affiliation": "Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.",
            "firstname": "Woo Jin",
            "initials": "WJ",
            "lastname": "Yang"
        },
        {
            "affiliation": "Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.\nCenter for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.",
            "firstname": "Danbee",
            "initials": "D",
            "lastname": "Kang"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.",
            "firstname": "Ji-Hee",
            "initials": "JH",
            "lastname": "Sung"
        },
        {
            "affiliation": "Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.",
            "firstname": "Myung Gyu",
            "initials": "MG",
            "lastname": "Song"
        },
        {
            "affiliation": "Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.",
            "firstname": "Hyejeong",
            "initials": "H",
            "lastname": "Park"
        },
        {
            "affiliation": "Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.\nDepartment of Big Data Research and Development, National Health Insurance Service, Wonju, Republic of Korea.",
            "firstname": "Taegyun",
            "initials": "T",
            "lastname": "Park"
        },
        {
            "affiliation": "Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.\nCenter for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.",
            "firstname": "Juhee",
            "initials": "J",
            "lastname": "Cho"
        },
        {
            "affiliation": "Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.",
            "firstname": "Tae-Seok",
            "initials": "TS",
            "lastname": "Seo"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.",
            "firstname": "Soo-Young",
            "initials": "SY",
            "lastname": "Oh"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.",
    "doi": "10.1093/hropen/hoae043",
    "journal": "Human reproduction open",
    "keywords": [
        "adverse neonatal events",
        "attention-deficit/hyperactivity disorder",
        "major congenital malformations",
        "postpartum hemorrhage",
        "preterm birth",
        "uterine artery embolization"
    ],
    "methods": null,
    "publication_date": "2024-07-22",
    "pubmed_id": "39036364\n20925139\n20237047\n25023434\n3558716\n29962865\n28950018\n12548162\n28937571\n33436979\n32458009\n11950179\n20381035\n24941178\n31608524\n22284667\n30016336\n32184677\n38514907\n32925974\n29879945\n33975876\n20185982\n36786903\n32956490\n26822938\n28615049\n34413380\n35235572\n24351791\n12660283\n26747667\n27229338\n20732945\n25166882",
    "results": null,
    "title": "Association between uterine artery embolization for postpartum hemorrhage and second delivery on maternal and offspring outcomes: a nationwide cohort study.",
    "xml": "<Element 'PubmedArticle' at 0x78850360e0c0>"
}