Feature
An undelivered promise
Pregnancy loss and IR By Sarah Lewis, FNP-BC, Paul B. Lewis, MD, MBA
T
he stork glides effortlessly and alone through the clear, blue sky. Its sturdy, white body is balanced with black tipped
wings spread wide. Hanging from its beak is the swaddled, uncomplicated promise of life. This symbol of hope and arrival is often the first picture of pregnancy for many. Most carry that image forward, unbroken—but for an estimated 10–15% of women, that serene picture is overtaken by clouds of uncertainty, turbulence of grief and storms of loss.1,2
A pregnancy loss can
take many forms: chemical pregnancy loss, early spontaneous miscarriage, blighted ovum, ectopic pregnancy, medical abortion, molar pregnancy, late miscarriage and stillborn. This article
14 IRQ | SPRING 2025
reviews the role IR takes in the care surrounding pregnancy loss and offering support for colleagues who may be navigating the personal experience.
The role of IR in pregnancy loss The least emergent role IR may take during pregnancy loss is performing a hysterosalpingogram (HSG). The indication for HSG is the evaluation for structural abnormalities contributing to the loss. These abnormalities span from intrauterine fibroids to blockages in fallopian tubes. While HSG is an aging procedure to the more current sonohysteroscopy, HSG allows concomitant fallopian tube recanalization to be performed, if indicated. In the event that intrauterine
fibroids are contributing to recurrent pregnancy loss, IR can offer uterine artery embolization (UAE). As we know, pregnancy is possible after UAE,3,4
and in
the case of prohibitive fibroids, UAE may allow a successful pregnancy.
At the time of pregnancy loss, IR may be called to prevent anticipated significant blood loss or treat life-threatening bleeding. The obstetrician may perform dilation and curettage (D&C) or dilation and evacuation (D&E). To address concerns for significant blood loss related to invasive or adherent placental tissue and/or cultural beliefs of the patient, IRs can work less selectively and with a collaborative approach to offer different options. If time allows, IRs can perform a UAE to reduce blood flow to the postpartum uterus. In more urgent settings, IR can assist in the perioperative period with prophylactic balloon occlusion in the bilateral internal iliac arteries or aorta.5
In the cases of
balloon occlusion, IR may have the opportunity to work collaboratively with the obstetrics team in the operating room during their procedure to optimize the occlusion time. Most often, IR is
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