AI Article Synopsis

  • This study investigates the effectiveness of uterine artery embolization (UAE) with gelatin foam to manage delayed bleeding caused by vascularized retained products of conception (vRPOC) after abortion or miscarriage during a 5-year period at 11 French hospitals.
  • Out of 224 patients evaluated, 94.2% experienced clinical success, although 7.3% showed persistent vRPOC at imaging follow-ups, with some minor and major complications reported.
  • The results suggest that while UAE with gelatin foam is generally safe and effective, certain factors like having a hypertrophic uterine artery and using gelatin foam torpedoes may increase the risk of persistent bleeding issues.

Article 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.

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Source
http://dx.doi.org/10.1007/s00330-024-11199-0DOI Listing

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