Abstract
BackgroundRetained 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.MethodsBetween 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.ResultsTechnical 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.ConclusionUAE using GS may be an effective and safe treatment for RPOC with hemorrhage that can preserve fertility.
Highlights
Retained products of conception (RPOC) with hemorrhage need intervention when RPOC persist and remain symptomatic
The purpose of this study is to retrospectively investigate the efficacy of uterine artery embolization (UAE) for RPOC with bleeding and future pregnancy outcomes
The left uterine artery (UA) was a source of bleeding from RPOC and embolized with success
Summary
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. Retained products of conception (RPOC) is defined as a condition of persistent placental tissue in the uterine cavity after abortion or delivery. Uterine artery embolization (UAE) for RPOC has been reported as a case report (Kitahara et al, 2011) or case series (Bazeries et al, 2017), but the safety and efficacy of 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
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