Choosing the uterine preservation surgery for placental polyp determined by blood flow evaluation: A retrospective cohort study

Abstract

BackgroundA placental polyp is an intrauterine polypoid mass or pedunculated mass occurring from residual trophoblastic tissue following abortion, cesarean section or vaginal delivery. Recently uterine preservation surgery represented by transcervical resection (TCR) has been performed for placental polyps. However TCR without intravascular intervention, including uterine artery embolization (UAE) may cause profound bleeding which necessitate emergency laparotomy.MethodsSeventeen cases of placental polyp were retrospectively examined. We divided cases into two groups: strong vascularity group (n = 13) and weak vascularity group (n = 4). Mass extraction of polyp by TCR was conducted in 16 cases, 6 case without UAE and 10 cases with UAE.ResultsAs for the weak vascularity group, one case was naturally resolved while planning surgery and 3 cases were treated with TCR without UAE without major intra- and/or postoperative bleeding. On the other hand in the strong vascularity group, 2 out of 3 cases of TCR without UAE resulted in major bleeding during and after the surgery, both needed transfusion and one needing postoperative UAE. Ten cases of strong vascularity group, TCR with UAE were performed and all of them were accomplished without major bleeding. TCR without UAE was safely performed in cases where there was absent or mild to moderate blood flow.ConclusionsOur report suggests that adding UAE might be safer to treat placental polyps that have strong vascularity.

Removal of retained products of conception showing marked vascularity without uterine artery embolization: Two case reports

“…Thus, before this protocol involving the maximum laminaria procedure and targeted removal of RPOC, as a cautionary measure, we set up UAE as backup. In patients with massive bleeding, UAE is better than hysterectomy if they desire more pregnancies . We explained the treatment strategies including UAE and hysterectomy to the patients before the treatment and they agreed to all the procedures before we commenced.…”

“…However, this angiographic technique uses contrast medium; the patient would be exposed to radiation and the arterial puncture is invasive. Further, UAE might cause uterine amenorrhea although most cases reported preserved fertility . Compared with UAE, the maximum laminaria procedure and targeted RPOC removal is easier and less invasive.…”

“…Retained products of conception (RPOC) with marked vascularity can cause massive postabortal or post‐partum hemorrhage . These clinical presentations resemble placental polyps and uterine artery pseudoaneurysms .…”

“…Uterine artery embolization (UAE) is presumed to be effective in preserving the uterus and is widely performed before the removal of RPOC. Recently, series of cases involving patients treated via UAE followed by transcervical resection (TCR) were reported . In almost all the cases, the uterus was well‐preserved.…”

Pólipo placentario hipervascular posparto

“…Ocurren con mayor frecuencia después del aborto terapéutico o inducido y parto espontáneo, y solo existen algunos informes de casos publicados en la literatura después de un aborto espontáneo (3) . Otros factores de riesgo identificados incluyen anomalías müllerianas que contribuyen a la placentación anormal y en pacientes con antecedentes de acretismo placentario combinada con atonía uterina (6,7) . También existen informes que describen que pueden surgir del sitio de inserción placentaria y en pacientes con antecedentes de tratamiento con radiación pélvica durante la infancia (8,9) .…”