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Kimura Y, Osuga K, Nagai K, Hongyo H, Tanaka K, Ono Y, Higashihara H, Matsuzaki S, Endo M, Kimura T, Tomiyama N. The efficacy of uterine artery embolization with gelatin sponge for retained products of conception with bleeding and future pregnancy outcomes. CVIR Endovasc 2020; 3:13. [PMID: 32052234 PMCID: PMC7016069 DOI: 10.1186/s42155-020-00107-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/06/2020] [Indexed: 12/18/2022] Open
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.
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Affiliation(s)
- Yasushi Kimura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan.
| | - Keigo Osuga
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi Takatsuki, Osaka, Japan
| | - Keisuke Nagai
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Hidenari Hongyo
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Kaishu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, Japan
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Camacho A, Ahn EH, Appel E, Boos J, Nguyen Q, Justaniah AI, Faintuch S, Ahmed M, Brook OR. Uterine Artery Embolization with Gelfoam for Acquired Symptomatic Uterine Arteriovenous Shunting. J Vasc Interv Radiol 2019; 30:1750-1758. [DOI: 10.1016/j.jvir.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/10/2023] Open
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Delplanque S, Le Lous M, Proisy M, Joueidi Y, Bauville E, Rozel C, Beraud E, Bruneau B, Levêque J, Lavoué V, Nyangoh Timoh K. Fertility, Pregnancy, and Clinical Outcomes after Uterine Arteriovenous Malformation Management. J Minim Invasive Gynecol 2019; 26:153-161. [DOI: 10.1016/j.jmig.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/14/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
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Usui H, Sato A, Okayama J, Suzuki Y, Omoto A, Shozu M. Removal of retained products of conception showing marked vascularity without uterine artery embolization: Two case reports. J Obstet Gynaecol Res 2018; 44:1482-1486. [PMID: 29956407 DOI: 10.1111/jog.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/08/2018] [Indexed: 12/15/2022]
Abstract
Retained products of conception with marked vascularity can cause massive postabortal or post-partum bleeding. Uterine artery embolization is effective for uterus preservation but does not assure fertility preservation. Thus, the optimal treatment for retained products of conception with marked vascularity is uncertain. Here, we report two cases of retained products of conception with marked vascularity: one early abortion and one hydatidiform mole, which were successfully resolved by dilation and removal of the retained products, without uterine artery embolization. We pretreated the cervical dilation using two or more laminaria tents and named this technique the 'maximum laminaria procedure'. We observed that the vascularity disappeared just after the laminaria tents were removed, and subsequently, we could remove the retained products with minimal bleeding, without uterine artery embolization. This protocol might become a standard treatment for retained products of conception with marked vascularity.
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Affiliation(s)
- Hirokazu Usui
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Gynecology, Chiba University Hospital, Chiba, Japan
| | - Asuka Sato
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Gynecology, Chiba University Hospital, Chiba, Japan
| | - Jun Okayama
- Department of Maternal-Fetal Medicine, Chiba University Hospital, Chiba, Japan
| | - Yoshiya Suzuki
- Department of Maternal-Fetal Medicine, Chiba University Hospital, Chiba, Japan
| | - Akiko Omoto
- Department of Maternal-Fetal Medicine, Chiba University Hospital, Chiba, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Gynecology, Chiba University Hospital, Chiba, Japan
- Department of Maternal-Fetal Medicine, Chiba University Hospital, Chiba, Japan
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Acquired uterine arteriovenous malformation in caesarean scar after a previous ectopic pregnancy: A case report. Eur J Obstet Gynecol Reprod Biol 2018; 224:203-204. [DOI: 10.1016/j.ejogrb.2018.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/17/2018] [Indexed: 11/21/2022]
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Tullius TG, Ross JR, Flores M, Ghaleb M, Kupesic Plavsic S. Use of three-dimensional power Doppler sonography in the diagnosis of uterine arteriovenous malformation and follow-up after uterine artery embolization: Case report and brief review of literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:327-334. [PMID: 25042165 DOI: 10.1002/jcu.22210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 04/03/2014] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
Arteriovenous malformations (AVM) of the uterus can cause life-threatening hemorrhage. Unexplained, heavy vaginal bleeding in a reproductive age woman should raise suspicion for an AVM. Here a 37-year-old woman had increasingly severe vaginal bleeding for 15 days. Serum β-hCG was elevated. Two-dimensional transvaginal ultrasound suggested retained products of conception. Before dilation and curettage (D&C), color Doppler and three-dimensional (3D) power Doppler demonstrated findings indicative of uterine AVM. A bilateral uterine artery embolization was performed without complications. Three months after uterine artery embolization, 3D power Doppler ultrasonography found complete resolution of the AVM. This case illustrates the importance of assessing both gray-scale and 3D power Doppler, and the ability of postprocedure Doppler to assess resolution.
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Affiliation(s)
- Thomas G Tullius
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Lee TY, Kim SH, Lee HJ, Kim MJ, Lee SK, Kim YH, Cho SH. Ultrasonographic indications for conservative treatment in pregnancy-related uterine arteriovenous malformations. Acta Radiol 2014; 55:1145-52. [PMID: 24338371 DOI: 10.1177/0284185113514222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Uterine arteriovenous malformations (AVMs) are known to spontaneously regress. PURPOSE To assess the predictive value of ultrasonography for patients requiring conservative treatment for pregnancy related to AVMs. MATERIAL AND METHODS Our prospective study included 75 patients (conservative management:therapeutic management = 45:30) with vaginal bleeding from pregnancy-related AVM. Clinical and ultrasonography examinations were reviewed, and the following information was gathered: complete blood count, AVM maximal diameter, AVM echogenicity, retained product of conception, number of blood vessels, and spectral Doppler (pulsatility index [PI], resistance index [RI], peak systolic velocity [PSV], time-averaged maximum velocity [TAMXV]). The Doppler criteria by Timmerman (mean PSV >70 cm/s: therapeutic management, mean PSV < 52 cm/s: conservative management) were used for the initial management selection. The association between experimental variables and outcomes was assessed to determine their usefulness for predicting conservative management. RESULTS Features strongly associated with conservative management and their accuracy were PSV 89.6%, hemoglobin 84.7%, RI 83.1%, TAMXV 79.3%, and PI 78.6%. The overall accuracy for correct outcome classification was 64 (85.3%) of 75 patients. Most patients with conservative management had quicker improvement of symptoms and spontaneous regression at follow-up. CONCLUSION Ultrasonography can accurately predict selection of conservative management.
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Affiliation(s)
- Tae Young Lee
- Keimyung University, Dongsan Hospital, Department of Radiology, Republic of Korea
| | - See Hyung Kim
- Keimyung University, Dongsan Hospital, Department of Radiology, Republic of Korea
| | - Hee Jung Lee
- Keimyung University, Dongsan Hospital, Department of Radiology, Republic of Korea
| | - Mi Jeong Kim
- Keimyung University, Dongsan Hospital, Department of Radiology, Republic of Korea
| | - Sang Kwon Lee
- Keimyung University, Dongsan Hospital, Department of Radiology, Republic of Korea
| | - Young Hwan Kim
- Keimyung University, Dongsan Hospital, Department of Radiology, Republic of Korea
| | - Seung Hyun Cho
- Kyungbook National University Hospital, Department of Radiology, Republic of Korea
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Selby ST, Haughey M. Uterine arteriovenous malformation with sudden heavy vaginal hemmorhage. West J Emerg Med 2013; 14:411-4. [PMID: 24106528 PMCID: PMC3789894 DOI: 10.5811/westjem.2012.12.13025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/16/2012] [Accepted: 12/12/2012] [Indexed: 11/12/2022] Open
Abstract
Dysfunctional uterine bleeding (DUB) is a common presentation in the emergency department and has a wide differential. Most presentations of DUB are in hemodynamically stable patients and can be evaluated as an outpatient. Uterine arteriovenous malformation (AVM) is one presentation that can result in a life-threatening medical emergency with unexpected sudden and massive vaginal bleeding. We describe a case of a 24-year-old female with sudden heavy vaginal bleeding requiring a blood transfusion, ultrasound evidence of uterine AVM, and a treatment method of expectant management using an intrauterine device in an attempt to preserve fertility.
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Affiliation(s)
- Sarah T Selby
- Albert Einstein College of Medicine, Jacobi Medical Center, Department of Emergency Medicine, Bronx, New York
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Goyal S, Goyal A, Mahajan S, Sharma S, Dev G. Acquired uterine arteriovenous malformation developing in retained products of conception: A diagnostic dilemma. J Obstet Gynaecol Res 2013; 40:271-4. [DOI: 10.1111/jog.12139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/25/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Surbhi Goyal
- Department of Pathology; University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital; Delhi India
| | - Ankur Goyal
- Department of Radiodiagnosis; All India Institute of Medical Sciences (AIIMS); New Delhi India
| | - Surbhi Mahajan
- Department of Pathology; University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital; Delhi India
| | - Shikha Sharma
- Department of Obstetrics and Gynaecology; University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital; Delhi India
| | - Geeta Dev
- Department of Pathology; University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital; Delhi India
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Clarke JA, Viswanatha RK, Hamid R, Sankaranarayanan S. Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence! BMJ Case Rep 2012; 2012:bcr-2012-007368. [PMID: 23213129 DOI: 10.1136/bcr-2012-007368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 23-year-old lady presented with a 10-month history of multiple episodes of prolonged and erratic menstrual bleeding having undergone a surgical termination of pregnancy. Initially, pelvic ultrasound and hysteroscopy were found to be normal and for many months she was treated pharmacologically for dysfunctional uterine bleeding. She also tried both a copper-coil and MIRENA intrauterine system, which were both expelled due to heavy bleeding characterised by 'a clot the size of two fists'. She required blood transfusions on multiple admissions, was forced to resign from her job and later became depressed. Under our care a transvaginal ultrasound scan showed a hypervascular region on the posterior uterine wall. An urgent hysteroscopy was performed due to her haemoglobin being 5.7 g/dl and revealed a pulsating lesion abutting the endometrium, which can be seen here on video. MR angiography confirmed an arteriovenous malformation and she was successfully treated with uterine artery embolisation.
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Peitsidis P, Manolakos E, Tsekoura V, Kreienberg R, Schwentner L. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet 2011; 284:1137-51. [DOI: 10.1007/s00404-011-2067-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
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Marcellin L, Haddad B, Kayem G. [Case study of a severe hemorrhage during a dilatation and curettage: Arteriovenous malformation or first trimester placenta accreta?]. ACTA ACUST UNITED AC 2010; 39:331-6. [PMID: 20434278 DOI: 10.1016/j.jgyn.2010.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 03/02/2010] [Accepted: 03/18/2010] [Indexed: 11/25/2022]
Abstract
A 27-year-old woman had a uterine curettage that was complicated by a severe hemorrhage. Ultrasonography and MRI showed a vascular lesion of the uterine fundus suspected to be an atypical arteriovenous malformation. The lesion spontaneously disappeared 2months later. The two most likely diagnoses are an arteriovenous malformation or a placenta accreta. The aim is to discuss the etiology of this serious complication from a case report of a severe hemorrhage during a uterine curettage.
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Affiliation(s)
- L Marcellin
- Department of Obstetrics and Gynecology, University Paris-XII, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France.
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