called to treat uncontrolled or persistent bleeding after D&C and D&E.


Postpartum hemorrhage (PPH) from pregnancy loss is comparable to that seen after live births. Large-volume bleeding can be addressed relatively nonselectively with UAE. A more focal bleed from a pseudoaneurysm after D&E can be embolized with super selective catheterization. The topic of emergent PPH management plans can be approached with a collaborative spirit and facilitate the conversation for elective UAE for fi broids.


The human factor Regardless of the role IR takes and what is treated, special attention should be given to who is treated. The patient with pregnancy loss—whether a new patient, friend, family or one of our own colleagues—is carrying the emotional weight from a broken promise of a new life. The following is not to replace or serve as clinical management, but is off ered as advice in supporting someone you may know navigating the diffi cult course. It is based on our own 8-year experience of recurrent pregnancy loss.


Particularly distinct to pregnancy loss is its grief. With the death of a parent or other family member, one has memories to hold onto, a memorial service or material items. In pregnancy loss the grief is prospective. Those going through pregnancy loss are grieving what would have been. They lost the child they thought they had, their identity as a mother or father, and the upcoming birthdays and life milestones that will not occur. They lost relating to those in their peer group who are still pregnant or actively parenting and moving into a new chapter of life without them. This can be markedly painful and isolating in the social realm of attending baby showers with a mutual friend group or answering well-meaning questions about family planning or an early pregnancy. In the setting of early pregnancy loss, many friends and coworkers are often unaware that a loss has occurred, and this can be even more diffi cult to navigate.


Colleagues and even close friends typically aren’t aware of a loss, as it is often held silently. This silent suff ering


impacts the patient internally and externally. With the loss of control in something that had all the right inputs and still an undesirable outcome, internal social anxiety plants itself and can expand over time. Help can be diffi cult for them because not everyone is comfortable discussing loss while others are but just can’t provide the right support. From our perspective: try anyway. Reinforce that they are allowed to hurt and deserve the time to process through their individual experience. Join alongside them and hold yourself to follow-up with continued support. When listening, listen to understand; do not off er unsolicited advice.


There are many diff erent facets of support. When asking what you can do to help, take consideration of the strengths in your existing relationship. You take one part of many: perhaps make a meal, listen to their most diffi cult thoughts or off er to sit with them quietly. As a physician, it is imperative to highlight the benefi ts of therapy. There is no condemnation in seeking professional help to work through pain that can be unbearable to carry.


If you have experienced a pregnancy loss, and if you are comfortable in doing so, share that with the patient. Hearing personally from one other person speaks infi nitely beyond any statistic that they are not alone. We learned that many people, even a few very close to us, had experienced a loss, and we could not thank them enough for sharing their story.


Regardless of your experience, and even if you feel uncertain or ill equipped, at least ask and listen. Your presence matters and nothing more may be needed. To us, it was surprising who did show up—and just as surprising who didn’t.


As it turns out, what is less often recognized is that storks, whether in sunny skies or storms, are naturally very social birds. They can even number into the hundreds during migration. In the same way, whether with a new patient, friend, family or one of our own colleagues, you can join their fl ock to help them fi nd community and understanding in their journey from darkness to light again.


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References


1. Bardos J, Hercz D, Friedenthal J, Missmer SA, Williams Z. A national survey on public perceptions of miscarriage. Obstet Gynecol. 2015;125(6):1313-20.


2. Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658-67.


3. Akhatova A, Aimagambetova G, Bapayeva G, Lagana AS, Chiantera V, Oppelt P, et al. Reproductive and obstetric outcomes after UAE, HIFU, and TFA of uterine fi broids: Systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20(5).


4. Bonduki CE, Feldner PC, Jr., Silva J, Castro RA, Sartori MG, Girao MJ. Pregnancy after uterine arterial embolization. Clinics (Sao Paulo). 2011;66(5):807-10.


5. Moirano J, Khoury J, Yeisley C, Noor A, Voutsinas N. Interventional radiology and pregnancy: From conception through delivery and beyond. Radiographics. 2023;43(8):e230029.


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