Appropriateness of treatments for postpartum and post-abortion uterine vascular anomalies

doi:10.1016/j.ejogrb.2025.02.041

. 2025 Apr 17:308:132-142.

doi: 10.1016/j.ejogrb.2025.02.041. Epub 2025 Feb 26.

Appropriateness of treatments for postpartum and post-abortion uterine vascular anomalies

Pierre-Antoine Barral¹, J Ghelfi², M Bravetti³, S Willoteaux⁴, A Agostini⁵, K Janot⁶, G Legendre⁷, A Torre⁸, M Midulla⁹, F Thouveny¹⁰, T Poclet¹¹, P Rousset¹², H Vernhet-Kovacsik¹³, A Jacquier¹⁴, H Marret¹⁵, Laura Miquel⁵

Affiliations

¹ Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France. Electronic address: pierre-antoine.barral@ap-hm.fr.
² University of Grenoble-Alpes, Saint Martin d'Hères, France; Department of Radiology, Grenoble-Alpes University Hospital, La Tronche, France; Institute for Advanced Biosciences - Institut national de la santé et de la recherche médicale (INSERM) U1209 - University of Grenoble-Alpes, La Tronche, France; University of Montpellier, Montpellier, France.
³ Centre cardiologique du nord, Saint-Denis, France.
⁴ Department of Radiology, University Hospital of Angers, France.
⁵ Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, Aix Marseille University, Marseille 13005, France.
⁶ Hôpital Bretonneau, université François-Rabelais de Tours, centre hospitalier régional universitaire de Tours, service de neuroradiologie interventionnelle, 37000 Tours, France.
⁷ Department of Gynecology and Obstetrics, CHU d'Angers, Angers CEDEX 01, France.
⁸ Division of Child Health, Obstetrics & Gynaecology - University of Nottingham, Maternity, City Hospital, Hucknall Road, NG5 1PB Nottingham, UK.
⁹ Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France.
¹⁰ Department of Radiology, Angers University Hospital, Angers, France.
¹¹ Department of Radiology, Valenciennes Hospital Center, 114 Avenue Desandrouin, 59300 Valenciennes, France.
¹² Department of Radiology, University Hospital Lyon Sud, Université Claude Bernard Lyon 1, CICLY, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France.
¹³ CHU de Montpellier, Arnaud de Villeneuve, service d'imagerie, 371, avenue Doyen Giraud, 34295 Montpellier, France.
¹⁴ Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; CRMBM - UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13385 Marseille Cedex 05, France.
¹⁵ Department of Oncologic and Pelvic Gynecologic Surgery, Pole de gynécologie obstétrique, Centre hospitalier universitaire Bretonneau, 2 boulevard Tonnellé, 37044 Tours Cedex 1, France.

PMID: 40048861
DOI: 10.1016/j.ejogrb.2025.02.041

Appropriateness of treatments for postpartum and post-abortion uterine vascular anomalies

Pierre-Antoine Barral et al. Eur J Obstet Gynecol Reprod Biol. 2025.

. 2025 Apr 17:308:132-142.

doi: 10.1016/j.ejogrb.2025.02.041. Epub 2025 Feb 26.

Authors

Affiliations

¹ Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France. Electronic address: pierre-antoine.barral@ap-hm.fr.
² University of Grenoble-Alpes, Saint Martin d'Hères, France; Department of Radiology, Grenoble-Alpes University Hospital, La Tronche, France; Institute for Advanced Biosciences - Institut national de la santé et de la recherche médicale (INSERM) U1209 - University of Grenoble-Alpes, La Tronche, France; University of Montpellier, Montpellier, France.
³ Centre cardiologique du nord, Saint-Denis, France.
⁴ Department of Radiology, University Hospital of Angers, France.
⁵ Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, Aix Marseille University, Marseille 13005, France.
⁶ Hôpital Bretonneau, université François-Rabelais de Tours, centre hospitalier régional universitaire de Tours, service de neuroradiologie interventionnelle, 37000 Tours, France.
⁷ Department of Gynecology and Obstetrics, CHU d'Angers, Angers CEDEX 01, France.
⁸ Division of Child Health, Obstetrics & Gynaecology - University of Nottingham, Maternity, City Hospital, Hucknall Road, NG5 1PB Nottingham, UK.
⁹ Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France.
¹⁰ Department of Radiology, Angers University Hospital, Angers, France.
¹¹ Department of Radiology, Valenciennes Hospital Center, 114 Avenue Desandrouin, 59300 Valenciennes, France.
¹² Department of Radiology, University Hospital Lyon Sud, Université Claude Bernard Lyon 1, CICLY, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France.
¹³ CHU de Montpellier, Arnaud de Villeneuve, service d'imagerie, 371, avenue Doyen Giraud, 34295 Montpellier, France.
¹⁴ Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; CRMBM - UMR CNRS 7339, Aix-Marseille University, 27, Boulevard Jean Moulin, 13385 Marseille Cedex 05, France.
¹⁵ Department of Oncologic and Pelvic Gynecologic Surgery, Pole de gynécologie obstétrique, Centre hospitalier universitaire Bretonneau, 2 boulevard Tonnellé, 37044 Tours Cedex 1, France.

PMID: 40048861
DOI: 10.1016/j.ejogrb.2025.02.041

Abstract

Purpose: Secondary postpartum and post-abortion hemorrhage due to uterine vascular anomalies can range from mild to life threatening episodes. Although clinicians have access to various treatment options, no studies have systematically evaluated their appropriateness across diverse clinical scenarios. This study aimed to assess the appropriateness of treatments for secondary postpartum and post-abortion hemorrhage using hypothetical scenarios that integrate different clinical presentations and imaging findings of uterine vascular anomalies.

Materials and methods: Applying the RAND/UCLA method, a panel of 14 French experts in gynecology and diagnostic and interventional radiology rated the appropriateness of various treatments for secondary postpartum/post-abortion hemorrhage. In addition, they rated questions regarding terminology and the diagnostic utility of color Doppler ultrasound and MRI.

Results: Of 290 clinical scenarios, 36 (12.4%) were rated as appropriate and 137 (47.2%) as inappropriate. Embolization with gelfoam alone, or followed by curettage or operative hysteroscopy was considered appropriate for various bleeding presentations in patients with extensive enhanced myometrial vascularity (EMV) adjacent to hypervascular Retained Products of Conception (RPOC). Embolization with gelfoam followed by curettage or operative hysteroscopy was deemed appropriate for patients with limited EMV and RPOC. In cases where EMV was present without RPOC, embolization with gelfoam was considered appropriate for abundant or recurrent bleeding leading to anemia.

Conclusion: These recommendations, which integrate clinical presentations, imaging evidence and patient pregnancy plan, offer valuable decision-making support for gynaecologists and radiologists in the managing of post-partum and post-abortion uterine vascular anomalies.

Keywords: RAND/UCLA appropriateness method; Secondary postpartum hemorrhage; Uterine arteriovenous malformations; Uterine vascular anomaly.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Pierre Antoine Barral reports a relationship with Medtronic that includes: consulting or advisory. Kevin Janot reports a relationship with Balt that includes: consulting or advisory. Pascal Rousset reports a relationship with ZIWIG that includes: consulting or advisory. Pascal Rousset reports a relationship with EDAP TMS that includes: consulting or advisory. Pascal Rousset reports a relationship with Medtronic that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. These recommendations are validated by the SIFEM (Societé d’Imagerie de la femme), the SFICV (Société Française d'Imagerie Cardiaque et Vasculaire Diagnostique et Interventionnelle) and the CNGOF (Collège national des gynécologues et obstétriciens). Pascal Rousset is consultant for ZIWIG, EDAP TMS, and MEDTRONIC. Kevin Janot is consultant for Balt. Pierre Antoine Barral is consultant for Medtronic.

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Appropriateness of treatments for postpartum and post-abortion uterine vascular anomalies

Affiliations

Appropriateness of treatments for postpartum and post-abortion uterine vascular anomalies

Authors

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Abstract

Conflict of interest statement

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Abstract

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