(172) Adverse obstetric outcomes following uterine artery embolization: a propensity-matched retrospective cohort study

Objective:
Our aim was to assess the risk of placenta accreta spectrum (PAS), adverse obstetric outcomes, and maternal morbidity in subsequent pregnancies following uterine artery embolization (UAE).

Study Design:
This was a descriptive study conducted using the TriNetX, a health research network with data from 105 unique health care organizations from 1/2010 to 7/2025. Patients between 12-55 years old with a unique pregnancy were included and divided into two 1:1 propensity score-matched cohorts: (1) pregnancy following a prior UAE and (2) pregnancy without a history of UAE. Pregnancy and UAE were verified using specific ICD10 and CPT codes. The primary outcome was the rate of PAS diagnosed during pregnancy. Secondary outcomes included rates of postpartum hemorrhage (PPH), placental abnormalities, and severe maternal morbidity (SMM) by Center for Disease Control (CDC) indicators. Statistical analyses were performed in the TriNetX platform.

Results:
1,378 pregnancies following a prior UAE and 4,084,738 pregnancies without a prior UAE were identified. The UAE-exposed cohort had significantly higher rates of obesity, diabetes, and hypertensive diseases, and were more likely to be non-white. After propensity score matching, a total of 1,378 patients were included in each cohort. UAE exposed patients had significantly higher odds of PAS (OR 7.21, 95% CI 3.70-4.06), PPH (OR 8.76, 95% CI 6.36-12.05), and retained placenta (OR 5.90 3.00-11.61) despite overall lower rates of Cesarean delivery (3.2% vs 8.4%). They also had a significantly higher odds of experiencing disseminated intravascular coagulation (6.55, 95% CI 3.35-12.83) and composite SMM (3.62, 95% CI 2.72-4.8). There were no differences in rates of placental abruption, placenta previa, or placental malformations.

Conclusion:
Pregnancies following UAE have significantly higher odds of PAS, PPH, and retained placenta. These results suggest an association between UAE and abnormal placentation in subsequent pregnancies, which should inform prenatal surveillance and delivery planning in UAE-exposed patients.