The efficacy of uterine artery embolization with gelatin sponge for retained products of conception with bleeding and future pregnancy outcomes

Kawakami, Yasushi; Osuga, Keigo; Nagai, Kiyoyuki; Hongyo, Hidenari; Tanaka, Kaishu; Ono, Yoshio; Higashihara, Hiroki; Matsuzaki, Shinya; Endo, Masayuki; Kimura, Tadashi; Tomiyama, Noriyuki

doi:10.1186/s42155-020-00107-4

Cited by 21 publications

(20 citation statements)

References 29 publications

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“…A previous retrospective study reported that the selective UAE is effective, without incidents or post-embolization complications, with a 74.2% (23/31) success rate in the primary UAE, and a combined success rate of 87.1% (27/31) in the primary and second UAE [ 12 ]. Another report showed that the technical and clinical success rate of UAE using a gelatin sponge for RPOC with hemorrhage was achieved without major complications in 93 and 100% of such cases, respectively [ 13 ]. These suggest that UAE may be useful for RPOC with marked vascularity, AVM, or EMV for preventing the risk of hemorrhage related to the surgical removal of the mass with methods such as curettage or operative hysteroscopy.…”

Section: Discussionmentioning

confidence: 99%

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Kobayashi

Nakagawa

Kawanishi

et al. 2021

BMC Pregnancy Childbirth

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Background The retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively. Methods We retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions. Results The range of gestational age at delivery in our study was 12–21 weeks in 61 cases, 22–36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9–47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively. Conclusion The long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.

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Section: Discussionmentioning

confidence: 99%

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Kobayashi

Nakagawa

Kawanishi

et al. 2021

BMC Pregnancy Childbirth

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“…Thus far, few reports have mentioned angiographic features of retained placenta in affected patients [5][6][7]. In those reports, angiographic features of retained placenta have included tortuous dilated uterine artery owing into a sac-like structure, intrauterine vascular lesion with or without arteriovenous (AV) shunt, focal contrast blush, and pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…Bazeries et al [5] reported that TAE technical and primary clinical successes, using mainly microspheres (size: 700-1200 µm), were achieved in 90.3% (27/31) and 74.2% (23/31) of their patients. Kimura et al [7] reported higher rates of TAE technical and clinical success using GS (93%, 13/14; 100%, 14/14). NBCA embolization of retained placenta increta was described in a case report; complete occlusion and cure was achieved with single embolization [16].…”

Section: Clinical Outcomementioning

confidence: 99%

Angiographic Features and Transarterial Embolization of Retained Placenta With Abnormal Vaginal Bleeding

Takaji

Kiyosue

Maruno

et al. 2021

Preprint

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Objectives: To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding.Methods: The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results: Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase (tentatively named “serpiginous blood sinus”) in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients.Conclusions: The characteristic angiographic feature of retained placenta is “serpiginous blood sinus.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.

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“…Studies have shown that up to 18% of retained products of conception have marked vascularity, resulting in increased risk of hemorrhage during surgical intervention (13). Some institutions use uterine artery embolization as an adjunct in the management of retained products of conception (14) or following prolonged post-partum hemorrhage when management with conservative measures has failed (15). Iatrogenic injury may also occur at the site of vascular access or bypass anastomosis, with pseudoaneurysms being reported as a complication of 1.4-4% of arterial anastomoses (Figure 3) (16).…”

Section: Iatrogenic Injurymentioning

confidence: 99%

Endovascular management of pelvic trauma

Weir¹,

Kennedy²,

Joyce³

et al. 2021

Ann Transl Med

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Traumatic pelvic injuries are an important group of acquired pathologies given their frequent association with significant vascular compromise. Potentially fatal as a consequence of rapid hemorrhage, achievement of early hemostasis is a priority; endovascular management of traumatic pelvic arterial injuries is an important potential option for treatment. Precipitated by any number of mechanisms of trauma, pelvic vascular injury necessitates timely patient assessment. Variable patterns of arterial injury may result from blunt, penetrating or iatrogenic trauma. Selection of the most appropriate imaging modality is a priority, ensuring streamlined access to treatment. In the case of CT, this is complemented by acquisition of the most appropriate phase of imaging; review of both arterial and delayed phase imaging improves the accuracy of detection of low-flow hemorrhage. In cases where surgical intervention is not deemed appropriate, endovascular treatment provides an alternative means for cessation of hemorrhage associated with pelvic injuries. This may be achieved in a selective or nonselective manner depending on the patient's clinical status and time constraints. Consequently, a detailed understanding of vascular anatomy is essential, including an appreciation of the normal variant anatomy between males and females. Additional consideration must be given to variant anatomy which may co-exist in both sexes. This review article aims to provide a synopsis of endovascular management of pelvic vascular injury. Through case examples, available treatment options will be discussed, including thrombin injection and transcatheter arterial embolization. Furthermore, potential adverse complications of pelvic arterial embolization will be highlighted. Finally, in view of the potential severity of these injuries, a brief overview of initial management of the hemodynamically unstable patient is provided.

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The efficacy of uterine artery embolization with gelatin sponge for retained products of conception with bleeding and future pregnancy outcomes

Cited by 21 publications

References 29 publications

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

Angiographic Features and Transarterial Embolization of Retained Placenta With Abnormal Vaginal Bleeding

Endovascular management of pelvic trauma

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