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Sundararajan S, Roy S, Polanski LT. The accuracy of ultrasound scan in diagnosing retained products of conception: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:512-531.e3. [PMID: 38008149 DOI: 10.1016/j.ajog.2023.11.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE This study aimed to analyze and summarize the evidence on the accuracy of different ultrasound methods in the diagnosis of retained products of conception. DATA SOURCES We searched Ovid SP, the Cumulative Register to Nursing & Allied Health Literature, EBSCO, and grey literature including Core, Trip, Networked Digital Library of Theses and Dissertations Global ETD search, BMJ Best Practice, PubMed, GreyLit report website (http://www.greylit.org/), Cochrane Central Register of Controlled Trials, and Google scholar (https://scholar.google.com/). STUDY ELIGIBILITY CRITERIA We included prospective and retrospective cross-sectional or Cohort studies that evaluated both ultrasound findings (before management of retained products of conception) and histopathologic results of retained products of conception at all gestational ages. METHODS We used Covidence for data extraction from the studies and quality assessment. The meta-analysis was performed using RevMan 5.4 (forest plot), MetaDTA version 2.01, and Meta-DiSc 2.0 online software. RESULTS In total, 11 studies were eligible for data extraction and meta-analysis. The total number of study participants from these 11 studies were 1567. Of these, 9 studies were included to test the accuracy of an echogenic mass, 4 studies analyzed the accuracy of endometrial thickness, and 5 studies analyzed the accuracy of color Doppler flow to predict retained products of conception. We found that echogenic mass had the highest sensitivity, specificity, and diagnostic odds ratio for predicting retained products of conception. The sensitivity, specificity, and diagnostic odds ratio were 0.915 (95% confidence interval, 0.844-0.955), 0.843 (95% confidence interval, 0.615-0.947), and 57.787 (95% confidence interval, 15.171-220.112), respectively. The diagnostic threshold for endometrial thickness was set at 10 mm with a sensitivity, specificity, and diagnostic odds ratio of 0.667 (95% confidence interval, 0.072-0.981), 0.866 (95% confidence interval, 0.375-0.986), and 12.927 (95% confidence interval, 0.23-726.582). The sensitivity, specificity, and diagnostic odds ratio of color Doppler flow were 0.850 (95% confidence interval, 0.756-0.913), 0.406 (95% confidence interval, 0.198-0.655), and 3.893 (95% confidence interval, 1.005-15.081). CONCLUSION Our review concluded that an echogenic mass is the most sensitive and specific predictor of retained products of conception after any pregnancy event. The most important limitation of our review is that the design of the studies included led to significant statistical heterogeneity.
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Affiliation(s)
- Srividya Sundararajan
- Department of Obstetrics and Gynaecology, Ipswich General Hospital, East Suffolk and North Essex NHS Trust, Ipswich, United Kingdom.
| | - Subhadeep Roy
- Department of Obstetrics and Gynaecology, West Suffolk Hospital NHS Trust, Bury St Edmunds, United Kingdom
| | - Lukasz T Polanski
- Department of Obstetrics and Gynaecology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough, United Kingdom
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Xholli A, Scovazzi U, Londero AP, Paudice M, Vacca I, Schiaffino MG, Kratochwila C, Cavalli E, Perugi I, Cagnacci A. Clinical and ultrasonographic characteristics of pregnancy-related enhanced myometrial vascularity: prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:672-682. [PMID: 37984401 DOI: 10.1002/uog.27537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To assess the ultrasonographic, epidemiological, clinical and evolutive characteristics of enhanced myometrial vascularity (EMV) following a first-trimester termination of pregnancy (TOP) or management of non-viable pregnancy. METHODS This prospective study included women who underwent follow-up ultrasound examination 5-6 weeks after a first-trimester TOP or after management of a first-trimester non-viable pregnancy at the University Hospital Polyclinic San Martino of Genoa between March 2021 and March 2022. EMV was characterized using two- and three-dimensional ultrasound and Virtual Organ Computer-aided Analysis. Ultrasonographic diagnosis of EMV was made when an unusual, tortuous myometrial vessel structure, with high-velocity blood flow, protruding towards the endometrium was observed, while an abnormal junctional zone, absent endometrial midline and heterogeneous endometrium supported the diagnosis. Patients with EMV underwent expectant management with planned ultrasonographic follow-up every 2 weeks until resolution. RESULTS During the study period, 305 women underwent TOP, of whom 132 attended the initial follow-up 5-6 weeks later, at which 52 were diagnosed with EMV. Ninety-six women were managed for a non-viable pregnancy, of whom 32 presented for follow-up, at which six had a diagnosis of EMV. Thus, overall, 164 of 401 women were included in the study and EMV was identified in 58 (35%) of these. The prevalence of EMV 5-6 weeks after a TOP was therefore between 52/305 (17%) and 52/132 (39%), and that after management of a non-viable pregnancy was between 6/96 (6%) and 6/32 (19%). Bleeding/pelvic pain was present in half (29/58) of the women with EMV, and serum human chorionic gonadotropin was detectable in 29% (17/58) at the first follow-up examination. At ultrasound assessment, all cases with EMV presented abundant tortuous myometrial vessels with high-velocity flow projecting from the myometrium towards the endometrium, along with non-uniform heterogeneous endometrium in 97% of cases, which often (67% of these) contained cystic areas, absence of the endometrial midline in 98% of cases and an abnormal junctional zone in 97% of cases (64% interrupted, 33% irregular). Most (67%) women with EMV were parous and 90% of them had undergone TOP rather than management for a non-viable pregnancy. Medical management of the TOP or non-viable pregnancy was more frequent in women with than those without EMV (93% vs 77%, P = 0.023). Multiple regression analysis showed the risk of EMV to be increased following TOP vs non-viable pregnancy (odds ratio (OR), 3.67 (95% CI, 1.16-11.56), P = 0.026) and in parous compared with nulliparous women (OR, 2.95 (95% CI, 1.45-6.01), P = 0.002). All women with EMV underwent expectant management. Eleven women did not return for subsequent follow-up examinations and did not present to our outpatient or emergency facilities, so were lost to further follow-up. Spontaneous resolution of the lesion was observed within 7-16 weeks after the procedure in 96% (45/47) of the remaining cases. Two women chose to undergo surgery for pelvic discomfort, and histology showed the presence of neovessels mixed with retained chorionic villi. CONCLUSIONS EMV is a transient and common finding 5-6 weeks following first-trimester TOP or management of non-viable pregnancy. TOP and being parous are risk factors for EMV. Expectant management of EMV is appropriate, because, in almost all cases, this resolves spontaneously, without complications, within 2-4 months. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Xholli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - U Scovazzi
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - A P Londero
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - M Paudice
- Department of Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- University of Genoa, Genoa, Italy
| | - I Vacca
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - M G Schiaffino
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - C Kratochwila
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - E Cavalli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - I Perugi
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - A Cagnacci
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
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Kishimoto N, Miyamoto M, Imauji A, Takada M, Nishitani S, Tanabe R, Ito T, Hada T, Otsuka Y, Takano M. Clinical significance of retained products of conception in placenta previa: a retrospective analysis. BMC Pregnancy Childbirth 2023; 23:481. [PMID: 37391723 DOI: 10.1186/s12884-023-05805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Retained products of conception (RPOC) often cause severe postpartum hemorrhage (PPH) but the clinical significance of RPOC in placenta previa is unclear. This study aimed to investigate the clinical significance of RPOC in women with placenta previa. The primary outcome was to evaluate risk factors of RPOC and the secondary outcome was to consider risk factors of severe PPH. METHODS Singleton pregnant women with placenta previa who underwent cesarean section (CS) and placenta removal during the operation at the National Defense Medical College Hospital between January 2004 and December 2021 were identified. A retrospective analysis was performed to examine the frequency and risk factors of RPOC and the association of RPOC with severe PPH in pregnant women with placenta previa. RESULTS This study included 335 pregnant women. Among these, 24 (7.2%) pregnant women developed RPOC. Pregnant women with prior CS (Odds Ratio (OR) 5.98; 95% Confidence Interval (CI) 2.35-15.20, p < 0.01), major previa (OR 3.15; 95% CI 1.19-8.32, p < 0.01), and placenta accreta spectrum (PAS) (OR 92.7; 95% CI 18.39-467.22, p < 0.01) were more frequent in the RPOC group. Multivariate analysis revealed that prior CS (OR 10.70; 95% CI 3.47-33.00, p < 0.01,) and PAS (OR 140.32; 95% CI 23.84-825.79, p < 0.01) were risk factors for RPOC. In pregnant women who have placenta previa with RPOC or without RPOC, the ratio of severe PPH were 58.3% and 4.5%, respectively (p < 0.01). Furthermore, the occurrence of prior CS (OR 9.23; 95% CI 4.02-21.20, p < 0.01), major previa (OR 11.35; 95% CI 3.35-38.38, p < 0.01), placenta at the anterior wall (OR 3.44; 95% CI 1.40-8.44, p = 0.01), PAS (OR 16.47; 95% CI 4.66-58.26, p < 0.01), and RPOC (OR 29.70; 95% CI 11.23-78.55, p < 0.01) was more in pregnant women with severe PPH. In the multivariate analysis for severe PPH, prior CS (OR 4.71; 95% CI 1.29-17.13, p = 0.02), major previa (OR 7.50; 95% CI 1.98-28.43, p < 0.01), and RPOC (OR 13.26; 95% CI 3.61-48.63, p < 0.01) were identified as risk factors. CONCLUSIONS Prior CS and PAS were identified as risk factors for RPOC in placenta previa and RPOC is closely associated with severe PPH. Therefore, a new strategy for RPOC in placenta previa is needed.
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Affiliation(s)
- Naohisa Kishimoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Akari Imauji
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Minori Takada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Soko Nishitani
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Risa Tanabe
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Tsubasa Ito
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Taira Hada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yuka Otsuka
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Bridwell R, Long B, Montrief T, Gottlieb M. Post-abortion Complications: A Narrative Review for Emergency Clinicians. West J Emerg Med 2022; 23:919-925. [DOI: 10.5811/westjem.2022.8.57929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
An abortion is a procedure defined by termination of pregnancy, most commonly performed in the first or second trimester. There are several means of classification, but the most important includes whether the abortion was maternally “safe” (performed in a safe, clean environment with experienced providers and no legal restrictions) or “unsafe” (performed with hazardous materials and techniques, by person without the needed skills, or in an environment where minimal medical standards are not met). Complication rates depend on the procedure type, gestational age, patient comorbidities, clinician experience, and most importantly, whether the abortion is safe or unsafe. Safe abortions have significantly lower complication rates compared to unsafe abortions. Complications include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis. Mortality rates for safe abortions are less than 0.2%, compared to unsafe abortion rates that range between 4.7-13.2%. History and physical examination are integral components in recognizing complications of safe and unsafe abortions, with management dependent upon the diagnosis. This narrative review provides a focused overview of post-abortion complications for emergency clinicians.
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Affiliation(s)
- Rachel Bridwell
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Tim Montrief
- Jackson Memorial Health System, Department of Emergency Medicine, Miami, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Expectant versus medical management for retained products of conception after medical termination of pregnancy: A randomized controlled study. Am J Obstet Gynecol 2022; 227:599.e1-599.e9. [PMID: 35752301 DOI: 10.1016/j.ajog.2022.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/05/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the rise of medical treatments for the termination of pregnancy, to-date no prospective trial has evaluated the efficacy of misoprostol in treating retained products of conception after induced termination of pregnancy. OBJECTIVE To compare medical management with misoprostol with expectant management for retained products of conception after first trimester medical termination of pregnancy. STUDY DESIGN An open-label randomized controlled trial conducted at a university-affiliated tertiary medical center. Consenting consecutive women who underwent a routine 3-week follow-up evaluation after medical termination of pregnancy and had a sonographic suspicion of retained products of conception, defined as sonographic evidence of intra-uterine remnant (>12 mm) with a positive Doppler flow, were recruited. The participants were randomized into a medical treatment group (800 mcg of sublingually administered misoprostol) or expectant management. They all underwent repeat ultrasound scans every 2 weeks until a maximum of 6 weeks, and those suspected for persistent retained products of conception were referred to operative hysteroscopy. The primary endpoint was successful treatment defined as no need for surgical intervention due to persistent retained products of conception within 8 weeks from pregnancy termination. RESULTS There were no significant differences in demographic characteristics between the study groups. The median sonographically demonstrated retained product length was 20 mm (interquartile range, [IQR] 17-25) in the medically managed group compared with 20 mm (IQR 17-26) in the expectantly managed group (P=.733). Treatment succeeded in 42/68 (61.8%) women in the medically managed group compared with 36/63 (57.1%) women in the expectantly managed group (relative risk [RR] = 1.12, 95% confidence interval [CI] 0.74-1.70; P=.590). There was no difference in adverse outcomes between the 2 groups. CONCLUSION There is no clinically meaningful advantage for medical treatment with misoprostol compared with expectant management after first trimester medical termination of pregnancy in women with suspected retained products of conception. Surgical intervention can be avoided in up to 60% of women who are managed expectantly over 8 weeks of follow-up.
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Enzelsberger SH, Wetzlmair D, Hermann P, Wagner H, Shebl O, Oppelt P, Trautner PS. Bleeding pattern after medical management of early pregnancy loss with mifepristone–misoprostol and its prognostic value: a prospective observational cohort study. Arch Gynecol Obstet 2021; 306:349-355. [PMID: 34694431 PMCID: PMC9349076 DOI: 10.1007/s00404-021-06291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/13/2021] [Indexed: 10/26/2022]
Abstract
Abstract
Purpose
To improve counseling of women by reporting bleeding characteristics at home after medical management of an early pregnancy loss (EPL) with mifepristone and misoprostol, and to evaluate occurring bleeding patterns as a prognostic tool.
Methods
This prospective two-center observational cohort study enrolled 197 women who presented with an EPL (embryonic or anembryonic miscarriage) from December 2017 to April 2019 and chose a home-based medical management with 200 mg mifepristone and 800 mcg misoprostol. From the day of mifepristone intake, the strength of vaginal bleeding was recorded daily for 2 weeks by the patient herself using a diary sheet. Treatment success was defined as no histologically confirmed retained products of conception (RPOC) within 3 months. After considering all drop-out criteria, 154 women were included in the analysis.
Results
40.0% of patients (95% CI 30.4–49.6) already reported bleeding onset in the time period between the intake of mifepristone and misoprostol. The median duration of vaginal bleeding including spotting was 13 days. The chance of RPOC was about sixfold (OR 6.06, 95% CI 2.15–17.10) in the group of persistent bleeding after 2 weeks compared to the group with a terminated bleeding at that time. Exploratory regression analysis indicated association of higher serum levels of leukocytes at treatment start with RPOC (p = 0.013).
Conclusions
Terminated bleeding after 2 weeks is a useful indicator for successful medical induction of EPL. Women undergoing medical treatment with mifepristone must be informed about the high frequency of bleeding onset before misoprostol intake.
Clinical trial registration
DRKS—German Clinical Trials Register, ID: DRKS00013515, registration date 05.12.2017. http://www.drks.de/DRKS00013515.
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Ali MK, Emam SM, Abdel-Aleem MA, Sobh AMA. Misoprostol versus expectant management in women with incomplete first-trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial. Int J Gynaecol Obstet 2021; 154:558-564. [PMID: 33615468 DOI: 10.1002/ijgo.13652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/09/2020] [Accepted: 02/19/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of repeat misoprostol versus expectant management in women with first-trimester incomplete miscarriage who have been initially treated with misoprostol. METHODS The study was an open-labeled randomized controlled trial including women with an incomplete first-trimester miscarriage after administration of misoprostol. The participants were randomly assigned to vaginal misoprostol or expectant management using a computer-generated table of random numbers. The primary outcome was the number of women with a complete miscarriage at 1 week. RESULTS Eighty-eight women (44 women in each group) were analyzed. The rate of complete miscarriage at 1 week was significantly higher in the misoprostol group than the expectant management group-29 (69.0%) versus 7 (16.7%) (P < 0.001), respectively. Women in the misoprostol group were more satisfied (7.00 ± 0.77 vs 4.57 ± 1.61, P < 0.001) but reported more pain (7.95 ± 1.85 vs 5.26 ± 1.08, P < 0.001) than women in the expectant group. The misoprostol group reported more adverse effects than the expectant management group (P < 0.001). CONCLUSION In women with an incomplete first-trimester miscarriage who were initially treated with misoprostol, repeat administration of misoprostol was more effective than expectant management for achieving complete miscarriage at 1 week. However, misoprostol was associated with more adverse effects. REGISTRATION SITE AND NUMBER Clinicaltrials.gov: NCT03148561.
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Affiliation(s)
- Mohammed K Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
| | - Samar M Emam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
| | - Mahmoud A Abdel-Aleem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
| | - Ahmed M A Sobh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
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Alessandrino F, Keraliya A, Lebovic J, Mitchell Dyer GS, Harris MB, Tornetta P, Boland GWL, Seltzer SE, Khurana B. Intimate Partner Violence: A Primer for Radiologists to Make the "Invisible" Visible. Radiographics 2020; 40:2080-2097. [PMID: 33006922 DOI: 10.1148/rg.2020200010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Intimate partner violence (IPV) is the physical, sexual, or emotional violence between current or former partners. It is a major public health issue that affects nearly one out of four women. Nonetheless, IPV is greatly underdiagnosed. Imaging has played a significant role in identifying cases of nonaccidental trauma in children, and similarly, it has the potential to enable the identification of injuries resulting from IPV. Radiologists have early access to the radiologic history of such victims and may be the first to diagnose IPV on the basis of the distribution and imaging appearance of the patient's currrent and past injuries. Radiologists must be familiar with the imaging findings that are suggestive of injuries resulting from IPV. Special attention should be given to cases in which there are multiple visits for injury care; coexistent fractures at different stages of healing, which may help differentiate injuries related to IPV from those caused by a stranger; and injuries in defensive locations and target areas such as the face and upper extremities. The authors provide an overview of current methods for diagnosing IPV and define the role of the radiologist in cases of IPV. They also describe a successful diagnostic imaging-based approach for helping to identify IPV, with a specific focus on the associated imaging findings and mechanisms of injuries. In addition, current needs and future perspectives for improving the diagnosis of this hidden epidemic are identified. This information is intended to raise awareness among radiologists, with the ultimate goal of improving the diagnosis of IPV and thus reducing the devastating effects on victims' lives. ©RSNA, 2020.
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Affiliation(s)
- Francesco Alessandrino
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Abhishek Keraliya
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Jordan Lebovic
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - George Sinclair Mitchell Dyer
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Mitchel B Harris
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Paul Tornetta
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Giles W L Boland
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Steven E Seltzer
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
| | - Bharti Khurana
- From the Departments of Radiology (F.A., A.K., G.W.L.B., S.E.S., B.K.) and Orthopaedic Surgery (G.S.M.D.) and the Trauma Imaging Research and Innovation Center (B.K.), Brigham and Women's Hospital; and Department of Orthopaedic Surgery, Massachusetts General Hospital (M.B.H.), Harvard Medical School (J.L.), 75 Francis St, Boston, MA 02115; and Department of Orthopaedic Surgery, Boston Medical Center, Boston University Medical School, Boston, Mass (P.T.)
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Stewart KT, Lee JS, Pan K, Albert AY, Fisher S. Outcome of using vaginal misoprostol for treatment of retained products of conception after first trimester miscarriage: a retrospective cohort study. EUR J CONTRACEP REPR 2020; 25:474-479. [PMID: 32869658 DOI: 10.1080/13625187.2020.1807498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Standard treatment for retained products of conception (RPOC) is dilation and curettage (D&C), however, this brings a risk of intrauterine synechiae and subsequent fertility issues. A treatment strategy to avoid D&C is medical management with misoprostol. The justification for misoprostol in this setting is extrapolated from miscarriage and termination literature, however, no studies have looked specifically in the setting of RPOC. The purpose of this study is to determine the efficacy of misoprostol as definitive management of RPOC. MATERIALS AND METHODS A retrospective cohort study was conducted from January 2016 to March 2017 at an Early Pregnancy Assessment Clinic. Patients diagnosed with RPOC with clinical symptoms and ultrasound findings of endometrial mass and/or doppler flow treated expectantly, medically with vaginal misoprostol or with a suction D&C underwent a chart review. Primary outcome was resolution of RPOC without surgical intervention. RESULTS AND CONCLUSIONS Of 1743 unique pregnancies, 189 women were diagnosed with RPOC. 34% (65/178) chose misoprostol for management of RPOC. Baseline demographics between the three treatment modalities (expectant, medical, surgical) were comparable. 65% (42/65) of patients who took misoprostol avoided D&C. Misoprostol is most effective (76%) in the setting of RPOC if the primary treatment for miscarriage was expectant management, with less success with primary medical management (44%) and primary surgical management (40%).
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Affiliation(s)
- K T Stewart
- Division of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - J S Lee
- Division of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.,Saskatchewan Cancer Agency, Regina, Canada
| | - K Pan
- Division of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - A Y Albert
- Women's Health Research Institute, BC Women's Hospital, Vancouver, Canada
| | - S Fisher
- Division of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
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10
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Vafaei H, Ajdari S, Hessami K, Hosseinkhani A, Foroughinia L, Asadi N, Faraji A, Abolhasanzadeh S, Bazrafshan K, Roozmeh S. Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study. BMC Complement Med Ther 2020; 20:145. [PMID: 32397980 PMCID: PMC7218551 DOI: 10.1186/s12906-020-02946-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background Myrrh (Commiphora myrrha (Nees) Engl.) has a long history of traditional use as a herbal medicine for different purposes. In ancient traditional Persian manuscripts, it has been noted that myrrh may act as uterine stimulant and probably cause complete abortion. However, there is no evidence to verify this comment. Therefore, the current study was carried out to evaluate the efficacy and safety of Myrrh in the treatment of incomplete abortion. Materials and methods In a randomized double-blinded placebo controlled clinical trial, 80 patients with ultrasound-documented retained products of conception (RPOC) were assigned to receive capsules containing 500 mg of Myrrh oleo-gum-resin or a placebo three times a day for 2 weeks. The existence of the retained tissue and its size were evaluated by ultrasound examination at the beginning and end of the study. Results After 2 weeks, the mean diameter of the RPOC in the Myrrh group was significantly reduced compared with the placebo group (P < 0.001). Meanwhile, the rate of successful complete abortion was 82.9% in the intervention group and 54.3% in the placebo group (P = 0.01). The patients in both groups reported no serious drug-related adverse effects. Conclusion This study shows that Myrrh is effective and safe in the resolution of the RPOC and may be considered as an alternative option for treatment of patients with incomplete abortion. However, further studies on active compounds isolated from myrrh and their uterine stimulant effects are needed. Trial registration This study was retrospectively registered at Iranian Registry of Clinical Trials (www.irct.ir) IRCT code: IRCT20140317017034N7.
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Affiliation(s)
- Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Ajdari
- Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ayda Hosseinkhani
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Foroughinia
- Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Box Hill Hospital, FRANZCOG Eastern Health, Victoria, Australia
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Maternal- Fetal Medicine (Perinatology), Hafez Hospital, Chamran Ave, Shiraz, Iran.
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Garofalo A, Desgro M. WITHDRAWN: Hysteroscopic removal of placental remnants using the Bigatti Shaver®: A mininvasive surgical approach. Eur J Obstet Gynecol Reprod Biol 2019:S0301-2115(19)30420-8. [PMID: 31551168 DOI: 10.1016/j.ejogrb.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Anna Garofalo
- Department of Gynecology and Obstetrics, San Giuseppe Hospital, University of Milan, Via San Vittore 12, Milano, Italy.
| | - Marcello Desgro
- Department of Gynecology and Obstetrics, San Giuseppe Hospital, University of Milan, Via San Vittore 12, Milano, Italy
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12
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Akiba N, Iriyama T, Nakayama T, Seyama T, Sayama S, Kumasawa K, Komatsu A, Yabe S, Nagamatsu T, Osuga Y, Fujii T. Ultrasonographic vascularity assessment for predicting future severe hemorrhage in retained products of conception after second-trimester abortion. J Matern Fetal Neonatal Med 2019; 34:562-568. [PMID: 31006292 DOI: 10.1080/14767058.2019.1610739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To investigate the spontaneous outcomes of vascularized retained products of conception (RPOC) detected by ultrasonography after second-trimester abortion, and to identify the predictive factors for the development of severe postpartum hemorrhage (SPPH).Study design: This is a retrospective cohort study on all cases after second-trimester abortion managed at our institute between January 2014 and December 2016. We assessed the associations between the occurrence of SPPH requiring invasive treatment and clinical factors including ultrasonographic findings (size and the vascularity status of RPOC classified as follows: type 1: vascularity confined to endometrium, type 2: vascularity reaching <1/2 myometrium, and type 3: vascularity reaching ≥1/2 myometrium) in vascularized RPOC cases.Results: Among 103 cases after second-trimester abortion, 19 patients (18.4%) were diagnosed as RPOC, and five patients eventually failed expectant management due to SPPH. Of them, 66.7% (4/6) of patients with type 3 developed SPPH as compared with 7.7% (1/13) of patients with type 1/type 2 (p < .05). The maximum vascularized mass diameter was significantly greater among the five patients who experienced SPPH than among the 14 patients who demonstrated spontaneous remission (43.0 ± 12.0 mm versus 20.7 ± 8.3 mm, p < .01). Patients with type 3 RPOC and a maximum vascularized mass diameter ≥30 mm, compared with other patients, demonstrated sensitivity, specificity, and risk ratio related to SPPH of 80, 92.9%, and 11.2, respectively.Conclusions: Our findings suggest that the ultrasonographic assessment of RPOC focused on the depth of vascularity in combination with the measurement of its size appears to be essential in determining women with RPOC who are at high risk for SPPH.
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Affiliation(s)
- Naoya Akiba
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Nakayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Seyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Komatsu
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Shinichiro Yabe
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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13
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Thangarajah F, Brunner M, Pahmeyer C, Radosa JC, Eichler C, Ludwig S, Morgenstern B, Mallmann P. Predictors of Postpartal Retained Products of Conception. In Vivo 2019; 33:469-472. [PMID: 30804127 DOI: 10.21873/invivo.11496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retention of products of conception (RPOC) following delivery is rare. Clinicians often have the impression that a high proportion of patients with sonographically suspected RPOC following surgery have a negative histopathology. Hence, we aimed to report our single-center experience with suspected RPOC and histopathological outcome after surgery. PATIENTS AND METHODS In this retrospective analysis, patients who underwent surgery due to suspected postpartum RPOC were analyzed for potential predictive clinical and sonographic parameters. RESULTS A total of 32 patients with histopathologically-confirmed RPOC were compared with 21 patients with a negative histopathological report for RPOC. Endometrial hyperechogenic mass and clinical parameters such as pain, fever and bleedings were not predictive for RPOC. Increased age (p=0.001) and vaginal delivery (p=0.040) were significantly associated with RPOC. CONCLUSION Clinical presentation alone is not predictive for RPOC. Vaginal delivery and younger age seem to be a risk factor and therefore have to be considered in patients with suspected RPOC.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany .,Breast Center, University Hospital Cologne, Cologne, Germany
| | - Magdalena Brunner
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Caroline Pahmeyer
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Julia Caroline Radosa
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, Homburg, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany.,Breast Center, University Hospital Cologne, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Bernd Morgenstern
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, University Hospital Cologne and Medical Faculty, Cologne, Germany
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Faure NP, Massardier J, Bolze PA, Hajri T, Devouassoux M, Golfier F, Rousset P. Tumeurs trophoblastiques gestationnelles : éléments clés dans notre pratique radiologique. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Wu S, Liang X, Cui X, Zuo D, Hong L, Chen K. Evaluating the Endometrial Hyperechoic Zone in Early Postpartum Women May Be Deceptive When Utilizing Transcutaneous Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318769029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the concordance of measurements for early postpartum endometrial thickness between magnetic resonance imaging (MRI) and transcutaneous diagnostic medical sonography (DMS) as well as its implications. The measurements of early postpartum endometrial thickness were reviewed across 51 postpartum women who underwent MRI and transcutaneous DMS. Additionally, 30 women with a normal menstrual cycle formed a control group, and their data were compared. The results indicated that the endometrial thickness at early postpartum was 4.63 ± 0.62 mm on MRI and 8.18 ± 4.70 mm on DMS, with a comparative significant difference ( P < .001). The endometrial thickness of the control group was 10.02 ± 1.71 mm on MRI and 10.17 ± 1.81 mm on DMS with no comparative significant difference ( P = .124). This cohort study questions whether the hyperechoic zone in the early postpartum uterine cavity represents the actual endometrial thickness. Care should be taken by sonographers in labeling the hyperechoic zone in the early postpartum stage as endometrium.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xian Liang
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Xiaojing Cui
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Dongsheng Zuo
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Lian Hong
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Kailiang Chen
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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16
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Kassam Z, Petkovska I, Wang CL, Trinh AM, Kamaya A. Benign Gynecologic Conditions of the Uterus. Magn Reson Imaging Clin N Am 2017; 25:577-600. [DOI: 10.1016/j.mric.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Kamaya A, Krishnarao PM, Nayak N, Jeffrey RB, Maturen KE. Clinical and imaging predictors of management in retained products of conception. Abdom Radiol (NY) 2016; 41:2429-2434. [PMID: 27853850 DOI: 10.1007/s00261-016-0954-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC). METHODS 334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians. Pelvic sonograms were retrospectively reviewed for endometrial stripe thickness and vascularity was graded on a 0-3 scale based on appearance relative to myometrium (Grade 0: no vascularity, Grade 1: minimal vascularity, Grade 2: moderate vascularity, Grade 3: marked vascularity). Clinical and imaging predictors of management were evaluated in univariate and multivariate analysis. RESULTS Mean patient age was 29.6 years and mean gestational age was 17.4 weeks. Most (74.4%) women presented with vaginal bleeding. 83 patients (47.2%) were treated conservatively with expectant management, 42 (23.8%) were treated medically, and 51 (29.0%) required surgical intervention. Mean endometrial stripe thickness was 21.3 mm. 47 women (26.7%) had vascularity score of 0; 50 (28.4%) had score 1; 52 (29.6%) had score 2; and 27 (15.3%) had score 3. In univariate analysis, serum hemoglobin (Hb) (p < 0.0001), endometrial stripe thickness on US (p < 0.005), presenting symptoms (p = 0.03), and US vascularity score (p < 0.005) were statistically significant predictors of final management. In multivariate logistic regression, serum Hb (OR 0.69, 95% CI 0.55-0.86, p < 0.0009), endometrial stripe thickness (OR 1.08, 95% CI 1.04-1.12, p < 0.0001), and US vascularity score (OR 1.77, 95% CI 1.16-2.70, p < 0.01) were statistically significant predictors of need for surgery. CONCLUSIONS Serum Hb, endometrial stripe thickness, and US vascularity score were significant predictors of clinical management, particularly the need for surgical intervention, in women with clinically suspected RPOC.
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Affiliation(s)
- Aya Kamaya
- Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
| | - Priya Menon Krishnarao
- Department of Radiology, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA, 95128, USA
| | - Nita Nayak
- Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - R Brooke Jeffrey
- Stanford University Medical Center, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Katherine E Maturen
- Department of Radiology, University of Michigan, 1500 E Med Ctr Dr, UH B1 D530H, Ann Arbor, MI, 48109, USA
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Tohma YA, Dilbaz B, Evliyaoğlu Ö, Çoşkun B, Çolak E, Dilbaz S. Is ultrasonographic evaluation essential for diagnosis of retained products of conception after surgical abortion? J Obstet Gynaecol Res 2016; 42:489-95. [DOI: 10.1111/jog.12944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/22/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yusuf Aytaç Tohma
- Başkent University, Department of Obstetric and Gynecology; Konya Turkey
| | - Berna Dilbaz
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital; Ankara Turkey
| | - Özlem Evliyaoğlu
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital; Ankara Turkey
| | - Bora Çoşkun
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital; Ankara Turkey
| | - Eser Çolak
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital; Ankara Turkey
| | - Serdar Dilbaz
- Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital; Ankara Turkey
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Long-term complications and reproductive outcome after the management of retained products of conception: a systematic review. Fertil Steril 2016; 105:156-64.e1-2. [DOI: 10.1016/j.fertnstert.2015.09.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022]
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20
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Wang PH, Chen CY, Chen CP. Ultrasound and Retained Products of Conception. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cheung KW, Ngu SF, Cheung VYT. Sonographic characteristics of the uterus in asymptomatic women after second-trimester medical termination of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:611-616. [PMID: 25792576 DOI: 10.7863/ultra.34.4.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the sonographic characteristics of the uterus after apparently uncomplicated second-trimester medical termination of pregnancy and to follow the evolution of these findings until the return of menstruation. METHODS Twenty-three women who requested termination of pregnancy at gestational ages between 14 and 20 weeks were recruited. Uterine characteristics were measured by 2- and 3-dimensional transvaginal with or without transabdominal sonography. The uterine anteroposterior diameter, length, and width, endometrial thickness, presence of an endometrial mass, intrauterine vascularity, and endometrial volume were measured within 24 hours, 1, 2, 4, 6, and 8 weeks after termination, and during the postmenstrual phase. RESULTS The mean uterine anteroposterior diameter, uterine length, uterine width, endometrial thickness, and endometrial volume ± SD deceased gradually from 66.1 ± 9.7 to 40.9 ± 5.3 mm, 131.4 ± 14.7 to 81.3 ± 13.8 mm, 84.6 ± 10.3 to 54.2 ± 7.6 mm, 25.6 ± 8.1 to 4.5 ± 2.6 mm, and 39.4 ± 22.6 to 2.5 ± 2.1 mL, respectively, from within 24 hours after termination to the postmenstrual phase. Endometrial masses were identified in 8 women (34.8%) within 4 weeks after termination, which could persist for up to 8 weeks. However, all endometrial masses resolved after menstruation. Minimal and moderate endometrial vascularity was detectable in up to 21.7% after termination; none was detectable in any women after menstruation. CONCLUSIONS This study provides information on the normal sonographic parameters of the uterus after second-trimester medical termination of pregnancy, which has been lacking in the literature. Also, our findings suggest that all endometrial masses regress with time; therefore, asymptomatic women with an incidental finding of an endometrial mass can be followed without the need for an immediate intervention.
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Affiliation(s)
- Ka Wang Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong.
| | - Siew-Fei Ngu
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Vincent Y T Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong
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Accurate Detection of Retained Products of Conception after First- and Second-trimester Abortion by Color Doppler Sonography. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Napolitano R, Ghosh M, Gillott DJ, Ojha K. Three-dimensional Doppler sonography in asymptomatic and symptomatic women after medical termination of pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:847-852. [PMID: 24764340 DOI: 10.7863/ultra.33.5.847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To characterize the 3D Doppler sonographic appearance of the uterine cavity in asymptomatic and symptomatic women after administration of mifepristone and misoprostol for medical termination of pregnancy. METHODS A prospective observational study was performed. Women admitted for medical termination of pregnancy underwent transvaginal sonography 15 days after the procedure. Volumes were acquired, and offline analyses of the 3D vascularization indices were performed. Outcomes were collected at the follow-up scan and by telephone after the termination. Women were subclassified as asymptomatic or symptomatic according to the presence/absence of fever, vaginal bleeding, abdominal/pelvic pain, and infections. Spotting was defined as any episodic vaginal bleeding that was less than an expected menstruation and not regarded as a symptom. RESULTS A total of 104 women who underwent medical termination of pregnancy between 6 and 9 weeks' gestation were enrolled in the study. The termination procedure was successful in 98% of cases; among them, 9 women (8.6%) were symptomatic due to bleeding. Two asymptomatic women required surgery; 1 had sonographic evidence of suspected retained products of conception (endometrial thickness ≥ 15 mm or power Doppler vascularization presence). Fifty-seven women (55%) presented with retained products of conception. All the women with suspected retained products regained normal menses; of these, 3 symptomatic women with retained products (2.9%) underwent a 1-month sonographic follow-up. The symptomatic status was not associated with endometrial thickness, 3D intrauterine mass volume, or 2-dimensional (2D) and 3D power Doppler appearances. CONCLUSIONS The necessity of surgery after medical termination of pregnancy cannot be predicted by sonography. In cases with sonographic evidence of suspected retained products of conception, endometrial thickness, 2D Doppler findings, and the 3D vascularization indices correlated poorly with bleeding symptoms. Long-term follow-up should be considered in symptomatic women, and it can avoid any unnecessary surgical intervention.
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Affiliation(s)
- Raffaele Napolitano
- Pregnancy Advisory Center, St George's University of London, Cranmer Terrace, London SW17 0RE, England.
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Tam T, Estes SJ. Hysteroscopic Morcellator Used in the Diagnosis and Evacuation of Retained Products of Conception. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Tam
- Division of Urogynecology and Minimally Invasive Gynecologic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Stephanie J. Estes
- Division of Reproductive Endocrinology and Infertility, all in Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Reid S, Casikar I, Condous G. The use of interventional ultrasound in early pregnancy complications. Australas J Ultrasound Med 2013; 16:22-25. [PMID: 28191168 PMCID: PMC5029974 DOI: 10.1002/j.2205-0140.2013.tb00093.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: The use of ultrasound to establish pregnancy location, viability and gestational age in the first trimester is well established. In addition to the conventional uses of ultrasound in early pregnancy, interventional ultrasound may also be used to guide clinicians during surgical procedures for the management of early pregnancy complications (i.e. treatment of ectopic pregnancy, caesarean section scar pregnancy, molar pregnancy, retained products of conception, and removal of intra-uterine devices in early pregnancy). Aims: This review discusses the role of interventional ultrasound as it pertains to the management of first trimester complications, particularly with regard to the use of ultrasound in conjunction with surgical modalities. Materials and Methods: This review was based on recently published research, as cited in the PubMed database, regarding the use of either transvaginal or transabdominal ultrasound to assist with the management of early pregnancy complications. Conclusions: In addition to the diagnostic capabilities of ultrasound in early pregnancy, interventional ultrasound plays an important role in the management of various first trimester pregnancy complications. With the advent of more conservative approaches to early pregnancy complications, interventional ultrasound is a viable option which is not only safe in experienced hands but also enables fertility preservation.
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Affiliation(s)
- Shannon Reid
- Acute Gynaecology Early Pregnancy Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University Sydney Penrith New South Wales Australia
| | - Ishwari Casikar
- Acute Gynaecology Early Pregnancy Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University Sydney Penrith New South Wales Australia
| | - George Condous
- Acute Gynaecology Early PregnancyAdvanced Endosurgery Unit Nepean MedicalSchool NepeanHospital University SydneyPenrith New South WalesAustralia; Omni Gynaecological Care CentreWomen's Ultrasound Early PregnancySt Leonards New South WalesAustralia
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Atri M, Rao A, Boylan C, Rasty G, Gerber D. Best predictors of grayscale ultrasound combined with color Doppler in the diagnosis of retained products of conception. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:122-127. [PMID: 21387325 DOI: 10.1002/jcu.20779] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 10/15/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To determine the best predictors of the presence of retained products of conception (RPOC) on grayscale and color Doppler transvaginal sonographic examination. METHODS This was a retrospective study of 91 consecutive patients who underwent transvaginal sonography (TVS) with color Doppler to evaluate for the presence of RPOC. The images of TVS studies were reviewed by two radiologists in consensus blinded to the final outcome. Data on a number of variables including endometrial measurable mass and focal increased color vascularity were collected as predictors of RPOC. The patients' ages ranged from 17 to 48 years (mean, 31.8 ± 6.8) and gestational age from 5 to 24 weeks (mean, 9.2 ± 3.8). Thirty-six were confirmed as RPOC by dilatation and curettage (D&C) and pathology. Fifty-five were considered negative, 9 based on D&C results and 46 on clinical grounds. RESULTS Sensitivity, specificity, negative- and positive-predictive and accuracy values were 81% (CI: 68%-94%), 71% (CI: 59%-83%), 85% (CI: 74%-95%), 64% (CI: 50%-78%), and 75% (CI: 66%-84%) to detect RPOC when a mass was present. The corresponding numbers for the presence of focal color vascularity were 94% (CI: 87%-100%) (p = 0.07), 67% (CI: 55%-80%) (p > 0.05), 95% (CI: 88%-100%) (p = 0.1), 65% (CI: 52%-78%) (p > 0.05), and 78% (CI: 70%-87%) (p > 0.05). Of the patients with confirmed RPOC on pathology, five had focal increased vascularity and no massand none had a mass without focal increased vascularity. CONCLUSION An area of focal increased vascularity with or without a mass is the best predictor of the presence of RPOC.
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Affiliation(s)
- M Atri
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5.
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Kitahara T, Sato Y, Kakui K, Tatsumi K, Fujiwara H, Konishi I. Management of retained products of conception with marked vascularity. J Obstet Gynaecol Res 2011; 37:458-64. [PMID: 21208344 DOI: 10.1111/j.1447-0756.2010.01363.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tomoko Kitahara
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Grum A, Michaelis S. Die lebensbedrohliche gynäkologische und geburtshilfliche Blutung. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elsayes KM, Trout AT, Friedkin AM, Liu PS, Bude RO, Platt JF, Menias CO. Imaging of the Placenta: A Multimodality Pictorial Review. Radiographics 2009; 29:1371-91. [DOI: 10.1148/rg.295085242] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kamaya A, Petrovitch I, Chen B, Frederick CE, Jeffrey RB. Retained products of conception: spectrum of color Doppler findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1031-1041. [PMID: 19643786 DOI: 10.7863/jum.2009.28.8.1031] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize color Doppler imaging features of retained products of conception (RPOC) with gray scale correlation. METHODS Clinically suspected cases of RPOC between January 2005 and February 2008 were reviewed. Patient data and relevant color Doppler and gray scale features were recorded. RESULTS A total of 269 patients referred for sonographic evaluation for RPOC were identified. Thirty-five patients had confirmed pathologic diagnoses, 28 of whom had RPOC. In those with RPOC, 5 (18%) were avascular (type 0); 6 (21%) had minimal vascularity (type 1); 12 (43%) had moderate vascularity (type 2); and 5 (18%) had marked vascularity (type 3). Peak systolic velocities ranged from 10 to 108 cm/s (average, 36.1 cm/s). Resistive indices in arterial waveforms ranged from 0.33 to 0.7 (average, 0.5). Five (45%) of the patients with type 0 vascularity had RPOC; 6 (86%) of those with type 1 had RPOC; and 17 (100%) of those with types 2 and 3 had RPOC. An echogenic mass had a moderate positive predictive value (80%) but low sensitivity (29%) for RPOC. CONCLUSIONS Color Doppler evaluation of the endometrium is helpful in determining the presence of RPOC. Endometrial vascularity is highly correlated with RPOC, whereas the lack of vascularity can be seen in both intrauterine clots and avascular RPOC.
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Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H1307, Stanford, CA 94305, USA
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