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Multicenter Study
. 2025 May;35(5):2499-2507.
doi: 10.1007/s00330-024-11199-0. Epub 2024 Nov 19.

Embolization with gelatin foam in the management of vascularized retained products of conception: a multicenter study by the French Society of Cardiovascular Imaging

Julien Ghelfi  1   2 , Clément Marcelin  3 , Alexandre Buisson  4   5 , Eliott Mathieu  4   6 , Loic Sentilhes  7 , Thibault Thubert  8 , Antoine Boizet  9 , Marco Midulla  10 , Hélène Kovacsik  11 , Sébastien Caudron  12 , Francine Thouveny  13 , Maxime Barat  14 , Julien Frandon  15 , Pierre-Antoine Barral  16 , Aurélie Delouche  4   6 , Arthur David  17
Affiliations
Multicenter Study

Embolization with gelatin foam in the management of vascularized retained products of conception: a multicenter study by the French Society of Cardiovascular Imaging

Julien Ghelfi et al. Eur Radiol. 2025 May.

Abstract

Objectives: Vascularized retained products of conception (vRPOC) are the most frequent cause of delayed hemorrhage after abortion, spontaneous miscarriage, or delivery. This study evaluated the efficacy of uterine artery embolization (UAE) with gelatin foam in the management of symptomatic of vRPOC.

Materials and methods: This retrospective study included patients who underwent UAE with gelatin foam for vRPOCs with vaginal bleeding between January 2018 and December 2022 in 11 French university hospitals. Embolization was performed using either gelatin foam torpedoes or sludge. The primary endpoint was the clinical success of embolization (cessation of bleeding at approximately 1 month after UAE). The secondary objectives were the success of imaging (no persistent vRPOC at imaging follow-up), the safety of UAE, and the predictive factors of clinical and imaging failure.

Results: Two hundred twenty-four patients (median age, 30.5 years ± 5.7 [standard deviation]) were included. Clinical success was achieved in 212 patients (94.2%). One hundred sixty-five patients had imaging follow-ups, among whom 12 patients (7.3%) had persistent vascularization. According to the SIR classification, 30 patients (13.4%) had minor complications, and two patients (0.8%) had major complications (endometritis n = 1; ischemic uterine necrosis n = 1). No predictive factors of clinical success were found, but the presence of a hypertrophic uterine artery (OR = 0.6 [0.38-0.97], p = 0.045) and the use of gelatin foam torpedoes (OR = 0.57 [0.42-0.77], p = 0.0012) were associated with a greater risk of persistent vRPOC on imaging control.

Conclusion: UAE with gelatin foam is safe and effective for treating hemorrhagic vRPOC.

Key points: Question Uterine vacuity is frequently observed on ultrasound after UAE for vRPOC. Findings A hypertrophic uterine artery and the use of gelatin foam torpedoes are associated with an increased risk of persistent vRPOC. Clinical relevance Embolization with gelatin foam is efficient and safe for treating bleeding in vRPOC.

Keywords: Gelatin foam; Retained products of conception; Uterine artery embolization; Vaginal bleeding.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Julien Ghelfi. Conflict of interest: The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Statistics and biometry: One of the authors has significant statistical expertise. Informed consent: Written informed consent was obtained for all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained (CRM-2304-340). Study subjects or cohorts overlap: None. Methodology: Retrospective Diagnostic or prognostic study Multicenter study

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