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. 2020 Feb 12;3(1):13.
doi: 10.1186/s42155-020-00107-4.

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

Yasushi Kimura  1 , Keigo Osuga  2 , Keisuke Nagai  3 , Hidenari Hongyo  3 , Kaishu Tanaka  3 , Yusuke Ono  3 , Hiroki Higashihara  3 , Shinya Matsuzaki  4 , Masayuki Endo  4 , Tadashi Kimura  4 , Noriyuki Tomiyama  3
Affiliations

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

Yasushi Kimura et al. CVIR Endovasc. .

Abstract

Background: Retained products of conception (RPOC) with hemorrhage need intervention when RPOC persist and remain symptomatic. The safety and efficacy of uterine artery embolization (UAE) for RPOC using gelatin sponge (GS) alone, and fertility after UAE for RPOC remain unknown. The purpose of this study is to retrospectively investigate the efficacy of UAE for RPOC with bleeding and future pregnancy outcomes.

Methods: Between 2007 and 2016, 14 patients (mean age, 33 years old) diagnosed as RPOC with bleeding received UAE using GS at our institution. Pregnancy outcomes were vaginal delivery (n = 7), miscarriage (n = 4), and termination (n = 3). Four patients received dilation and curettage/evacuation (D&C/E) for treatment of RPOC before bleeding occurred. The mean time interval from the end of pregnancy to bleeding was 28 days. Technical success, clinical success, complications, angiographic features and fertility after UAE were retrospectively assessed.

Results: Technical success was achieved in 13 patients (93%) and clinical success was achieved in all 14 patients. No major complications occurred. The angiographic features of RPOC were tortuous feeders with flow into a focal blush of contrast (n = 14). Additional findings were pseudoaneurysm (n = 6), early venous return (n = 4), and extravasation (n = 2). Pseudoaneurysm was observed significantly more often in patients who received D&C/E before UAE compared to those who received conservative treatment alone (P = 0.015). The mean follow-up period was 29 months. Six patients achieved six pregnancies an average of 29 months after UAE.

Conclusion: UAE using GS may be an effective and safe treatment for RPOC with hemorrhage that can preserve fertility.

Keywords: Post-partum hemorrhage; Retained products of conception; Uterine artery embolization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
31-year-old patient with vaginal bleeding after vaginal delivery. a Transvaginal ultrasonography showing a hypervascular hyperechoic mass in the endometrium. b Arterial-phase contrast enhanced CT showing focal enhancement (arrow) within the endometrium. c Aortography showing numerous spiral arteries and a focal blush in the left side of uterus (arrow). d Post-embolization aortography showing contrast stasis without focal blush
Fig. 2
Fig. 2
32-year-old patient with vaginal bleeding post D&C for missed abortion. a Trans-abdominal ultrasonography showing a hypervascular intrauterine mass. b Arterial-phase CE-CT showing an enhancing lesion in the uterine cavity (arrow). c Left uterine arteriogram showing a focal blush (arrow) and a pseudoaneurysm (arrowhead). d Post-embolization left uterine arteriogram confirming the disappearance of the pseudoaneurysm and focal blush
See this image and copyright information in PMC

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