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

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.

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.

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.

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.