Management of retained products of conception with marked vascularity
Management of retained products of conception with marked vascularity
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DOI：
10.1111/j.1447-0756.2010.01363.x
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发表时间：
2011-05-01
影响因子：
1.6
通讯作者：
Konishi, Ikuo
中科院分区：
文献类型：
--
作者：
Kitahara, Tomoko;Sato, Yukiyasu;Konishi, Ikuo
具有明显血管分布的妊娠产物残留（RPOC）病例存在临床挑战，因为简单的扩张和刮除（D&C）可导致危及生命的出血。我们在这里描述了两例多血管的RPOC，成功地管理与两种不同的方法。例一：一名26岁的女性，有3 D& C病史，在自然流产后45天因阴道大量出血被送往急诊室。考虑诊断为RPOC伴子宫肌瘤样结构，并进行子宫动脉栓塞。子宫动脉栓塞后4天，彩色多普勒超声检查证实RPOC的血管减少，并成功进行了D&C。病例2：一名37岁女性，曾剖宫产一次，月经正常后怀孕。她在妊娠8周时因过期流产接受了D&C。D&C后7天，超声检查在先前剖宫产瘢痕附近出现异质性肿块。此后，肿块逐渐增大，考虑诊断为多血管胎盘息肉。由于阴道出血量少，采取了保守治疗。第一次D&C后61天，彩色多普勒超声检查证实RPOC的血管减少，D&C成功完成。
Cases of retained products of conception (RPOC) with marked vascularity present a clinical challenge because simple dilation and curettage (D&C) can lead to life-threatening hemorrhage. We describe here two cases of hypervascular RPOC that were successfully managed with two different approaches. Case 1: A 26-year-old woman with history of 3 D&Cs was transported to the emergency room for heavy vaginal bleeding 45 days after a spontaneous abortion. Diagnosis of RPOC with aneurysm-like structure was considered and uterine artery embolization was performed. Four days after the uterine artery embolization, reduction of the vascularity of RPOC was confirmed on color Doppler ultrasonography and D&C was successfully carried out. Case 2: A 37-year-old woman with history of one cesarean section became pregnant after the regular menses. She underwent D&C for missed abortion at 8 weeks' gestation. Seven days after the D&C, sonographically heterogenous mass emerged in the vicinity of the previous cesarean scar. Thereafter, the mass gradually grew larger and diagnosis of hypervascular placental polyp was considered. As the amount of vaginal bleeding was small, expectant management was instituted. Sixty-one days after the first D&C, reduction of the vascularity of RPOC was confirmed on color Doppler ultrasonography and D&C was successfully completed.