Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment

Bazeries, P.; Paisant-Thouveny, Francine; Yahya, Sultan; Bouvier, Antoine; Nedelcu, C.; Boussion, F.; Sentilhes, Loïc; Willoteaux, S.; Aubé, Christophe

doi:10.1007/s00270-016-1543-7

Cited by 34 publications

(37 citation statements)

References 39 publications

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“…Bazeries et al 10 showed that in cases of RPOC with marked vascularity, minimally invasive UAE was an effective and safe first-line treatment. UAE is an effective treatment for post-partum hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Hysteroscopic removal of RPOC appears to be an increasingly popular technique associated with long‐term complications and reproductive outcome compared with dilation and curettage . In cases of active bleeding caused by RPOC and under surgical treatment, uterine artery embolization (UAE) is helpful for decreasing hemorrhage . However, while UAE is used to treat post‐partum hemorrhage and fibroids, the effect of UAE on fertility remains controversial and the effect after UAE for RPOC is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] In cases of active bleeding caused by RPOC and under surgical treatment, uterine artery embolization (UAE) is helpful for decreasing hemorrhage. 10 However, while UAE is used to treat postpartum hemorrhage and fibroids, the effect of UAE on fertility remains controversial and the effect after UAE for RPOC is unknown. Therefore, this study aimed to examine the complications and reproductive outcome after UAE for RPOC.…”

Section: Introductionmentioning

confidence: 99%

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Complications and reproductive outcome after uterine artery embolization for retained products of conception

Ohmaru-Nakanishi

Kuramoto

Maehara

et al. 2019

J of Obstet and Gynaecol

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Aim The purpose of this study was to evaluate the complications and reproductive outcome after uterine artery embolization (UAE) for retained products of conception (RPOC). Methods This was a retrospective medical‐records review study of 57 women treated for RPOC. Participants were divided into two groups: women who underwent treatment with UAE (UAE group: n = 32, 56.1%) and those without UAE (control group: n = 25, 43.9%). The complications and reproductive outcomes were compared between the two groups. Information on subsequent pregnancies and their outcomes was available for 30 women who attempted to conceive. Results There were no significant differences in the interval from the last delivery or abortion (40.1 ± 3.4 vs 51.0 ± 5.1 months, respectively; P = 0.16), the rate of severe bleeding under hysteroscopy (18.5 vs 9.1%, respectively; P = 0.65), the conception rate (58.8 vs 61.5%, respectively; P = 1.0) and mean time to conception (9.9 ± 1.6 vs 11.0 ± 2.9 months, respectively; P = 0.17) in women in the UAE group compared with those in the control group. Rates of post‐partum hemorrhage (PPH) and manual removal of placenta (25.0% in the UAE group and 16.7% in the control group, respectively) were higher than the general population. Conclusion Selective UAE for RPOC may be a preferable procedure in women who are suspected as having a risk of severe bleeding under treatment. Women who were treated for RPOC, regardless of UAE, were at risk of PPH and difficulty in removing the placenta in future pregnancies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complications and reproductive outcome after uterine artery embolization for retained products of conception

Ohmaru-Nakanishi

Kuramoto

Maehara

et al. 2019

J of Obstet and Gynaecol

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“…As previously reported, the evacuation procedure for RPOC with marked vascularity in the uterus might cause massive bleeding . Some obstetricians and gynecologists would prefer UAE . Thus, before this protocol involving the maximum laminaria procedure and targeted removal of RPOC, as a cautionary measure, we set up UAE as backup.…”

Section: Discussionmentioning

confidence: 99%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

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

Usui

Sato

Okayama

et al. 2018

J of Obstet and Gynaecol

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Retained products of conception with marked vascularity can cause massive postabortal or post-partum bleeding. Uterine artery embolization is effective for uterus preservation but does not assure fertility preservation. Thus, the optimal treatment for retained products of conception with marked vascularity is uncertain. Here, we report two cases of retained products of conception with marked vascularity: one early abortion and one hydatidiform mole, which were successfully resolved by dilation and removal of the retained products, without uterine artery embolization. We pretreated the cervical dilation using two or more laminaria tents and named this technique the 'maximum laminaria procedure'. We observed that the vascularity disappeared just after the laminaria tents were removed, and subsequently, we could remove the retained products with minimal bleeding, without uterine artery embolization. This protocol might become a standard treatment for retained products of conception with marked vascularity.

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Diagnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception

Groszmann

Murphy²,

Benacerraf

2018

Ultrasound in Obstet & Gyne

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An increasing number of studies describe the enhanced myometrial vascularity associated with retained products of conception as 'acquired arteriovenous malformation', with some recommending management with uterine-artery embolization. Our study demonstrates that the enhanced myometrial vascularity is associated with retained products of conception, and surgical removal by D&C, possibly with the aid of ultrasound guidance or hysteroscopy, is a safe treatment option. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment

Abstract: RPOC with MV can present with large uterine AV shunt, particularly in case of late management. Uterine artery embolization is an effective and safe first-line treatment, and should be evaluated for this indication in larger prospective trials.

Cited by 34 publications

References 39 publications

Complications and reproductive outcome after uterine artery embolization for retained products of conception

Complications and reproductive outcome after uterine artery embolization for retained products of conception

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

Diagnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception

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