Application of hysteroscopic treatment for retained products of conception combined with enhanced myometrial vascularity in ambulatory surgery mode_West China Medical Journal

Authors：

TANG Mingming ^1,2 , CUI Jing’en ³ , CHEN Hengxi ^1,2 , CHEN Yihong ^1,2 ,  TAN Xin ^1,2

1. Department of Day Surgery, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;
3. Department of Obstetrics, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing 401147, P. R. China;

Corresponding author：

TAN Xin, Email: Tan8336@icloud.com

Keywords：

Retained products of conception; enhanced myometrial vascularity; hysteroscopy; ambulatory surgery

DOI：

10.7507/1002-0179.202411370

Video：

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Objective To investigate the safety and feasibility of hysteroscopic treatment for retained products of conception (RPOC) combined with enhanced myometrial vascularity (EMV) in ambulatory surgery mode. Methods A retrospective analysis was conducted on the clinical data of patients who underwent hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode at West China Second University Hospital between May 2021 and May 2024, including their basic information and surgical related conditions. Results A total of 54 patients were included, with an average age of (33.37±4.54) years and an average number of pregnancies (3.14±1.56). The preoperative blood level of human chorionic gonadotropin was 11.45 (5.00, 82.96) mU/mL. Color Doppler ultrasound showed an average size of pregnancy residue (2.47±0.77) cm. The average peak systolic velocity was (55.13±18.55) cm/s. The intraoperative blood loss was 17.63 (1.00, 300.00) mL. The average surgical time was (30.07±20.64) minutes. The hospital stay was 0.69 (0.50, 1.00) days. There was 1 case of postoperative complications (incidence rate 1.9%), which had the second hysteroscopy to remove retained pregnancy tissue one month after the first surgery due to RPOC. There were 6 cases of postoperative re pregnancy. Conclusion Hysteroscopic treatment for RPOC combined with EMV in ambulatory surgery mode is safe and feasible, and is worth promoting.

1.	Ko JK, Cheung VY, Khongsni P. Management and outcome of sonographically diagnosed uterine enhanced myometrial vascularity / arteriovenous malformations following early pregnancy events: a single center experience. Med Ultrason, 2016, 18(3): 403-404.
2.	Woo J, Kahn B. Enhanced myometrial vascularity: case presentation and review. Fertil Steril, 2021, 116(3): 912-914.
3.	Kaelin Agten A, Ringel N, Ramos J, et al. Standardization of peak systolic velocity measurement in enhanced myometrial vascularity. Am J Obstet Gynecol, 2016, 215(6): 802-803.
4.	Timor-Tritsch IE, Haynes MC, Monteagudo A, et al. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity / arteriovenous malformations. Am J Obstet Gynecol, 2016, 214(6): 731.e1-731.e10.
5.	Dewilde K, Groszmann Y, Van Schoubroeck D, et al. Enhanced myometrial vascularity secondary to retained pregnancy tissue: time to stop misusing the term arteriovenous malformation. Ultrasound Obstet Gynecol, 2024, 63(1): 5-8.
6.	Grewal K, Al-Memar M, Fourie H, et al. Natural history of pregnancy-related enhanced myometrial vascularity following miscarriage. Ultrasound Obstet Gynecol, 2020, 55(5): 676-682.
7.	Gingold JA, Bradley LD. Use of hysteroscopy in diagnosis and follow-up of acquired uterine enhanced myometrial vascularity. Fertil Steril, 2020, 113(2): 460-462.
8.	O’Leary M, Sanders AP. Enhanced myometrial vascularity-the time has come for individualized treatment of focal uterine pathology. Fertil Steril, 2021, 116(3): 691-692.
9.	刘华英, 李玲, 史元湘, 等. ERAS 理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究. 陆军军医大学学报, 2024, 46(14): 1658-1665.
10.	吴世鹏, 李杰华, 覃积昊, 等. 日间手术模式下经胸前入路腔镜甲状腺癌根治术应用研究. 临床军医杂志, 2024, 52(10): 1060-1062.
11.	张传阳, 唐加热克, 杨建平, 等. 日间手术模式下射频消融闭合术治疗下肢静脉曲张的疗效评价. 血管与腔内血管外科杂志, 2024, 10(2): 134-138.
12.	夏萍, 王卫, 夏志鹏, 等. 日间手术全程管理模式探索及实践. 中国医院, 2023, 27(8): 99-101.
13.	Van den Bosch T, Van Schoubroeck D, Timmerman D. Maximum peak systolic velocity and management of highly vascularized retained products of conception. J Ultrasound Med, 2015, 34(9): 1577-1582.
14.	Ercolino C, Ferrazzi E, Ossola MW, et al. A comprehensive diagnostic approach to differentiate intrauterine arteriovenous malformation in cases of enhanced myometrial vascularity. Arch Gynecol Obstet, 2024, 310(5): 2523-2529.
15.	Vyas S, Choi HH, Whetstone S, et al. Ultrasound features help identify patients who can undergo noninvasive management for suspected retained products of conception: a single institutional experience. Abdom Radiol (NY), 2021, 46(6): 2729-2739.

1. Ko JK, Cheung VY, Khongsni P. Management and outcome of sonographically diagnosed uterine enhanced myometrial vascularity / arteriovenous malformations following early pregnancy events: a single center experience. Med Ultrason, 2016, 18(3): 403-404.
2. Woo J, Kahn B. Enhanced myometrial vascularity: case presentation and review. Fertil Steril, 2021, 116(3): 912-914.
3. Kaelin Agten A, Ringel N, Ramos J, et al. Standardization of peak systolic velocity measurement in enhanced myometrial vascularity. Am J Obstet Gynecol, 2016, 215(6): 802-803.
4. Timor-Tritsch IE, Haynes MC, Monteagudo A, et al. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity / arteriovenous malformations. Am J Obstet Gynecol, 2016, 214(6): 731.e1-731.e10.
5. Dewilde K, Groszmann Y, Van Schoubroeck D, et al. Enhanced myometrial vascularity secondary to retained pregnancy tissue: time to stop misusing the term arteriovenous malformation. Ultrasound Obstet Gynecol, 2024, 63(1): 5-8.
6. Grewal K, Al-Memar M, Fourie H, et al. Natural history of pregnancy-related enhanced myometrial vascularity following miscarriage. Ultrasound Obstet Gynecol, 2020, 55(5): 676-682.
7. Gingold JA, Bradley LD. Use of hysteroscopy in diagnosis and follow-up of acquired uterine enhanced myometrial vascularity. Fertil Steril, 2020, 113(2): 460-462.
8. O’Leary M, Sanders AP. Enhanced myometrial vascularity-the time has come for individualized treatment of focal uterine pathology. Fertil Steril, 2021, 116(3): 691-692.
9. 刘华英, 李玲, 史元湘, 等. ERAS 理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究. 陆军军医大学学报, 2024, 46(14): 1658-1665.
10. 吴世鹏, 李杰华, 覃积昊, 等. 日间手术模式下经胸前入路腔镜甲状腺癌根治术应用研究. 临床军医杂志, 2024, 52(10): 1060-1062.
11. 张传阳, 唐加热克, 杨建平, 等. 日间手术模式下射频消融闭合术治疗下肢静脉曲张的疗效评价. 血管与腔内血管外科杂志, 2024, 10(2): 134-138.
12. 夏萍, 王卫, 夏志鹏, 等. 日间手术全程管理模式探索及实践. 中国医院, 2023, 27(8): 99-101.
13. Van den Bosch T, Van Schoubroeck D, Timmerman D. Maximum peak systolic velocity and management of highly vascularized retained products of conception. J Ultrasound Med, 2015, 34(9): 1577-1582.
14. Ercolino C, Ferrazzi E, Ossola MW, et al. A comprehensive diagnostic approach to differentiate intrauterine arteriovenous malformation in cases of enhanced myometrial vascularity. Arch Gynecol Obstet, 2024, 310(5): 2523-2529.
15. Vyas S, Choi HH, Whetstone S, et al. Ultrasound features help identify patients who can undergo noninvasive management for suspected retained products of conception: a single institutional experience. Abdom Radiol (NY), 2021, 46(6): 2729-2739.

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