Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Japan.
Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Japan.
Taiwan J Obstet Gynecol. 2023 Sep;62(5):661-666. doi: 10.1016/j.tjog.2023.07.006.
To assess the clinical characteristics and endocrinological background of women with vascular retained products of conception (RPOC) after miscarriage or abortion and evaluate the effect of estrogen-progestogen therapy (EPT) as an initial treatment on this population based on their endocrinological background.
Women with vascular RPOC after miscarriage or abortion at less than 20 weeks of pregnancy who were given EPT (conjugated estrogen and norethisterone) were retrospectively reviewed. Their clinical characteristics, hormonal parameters, ultrasonographic findings, and outcomes were evaluated.
Of 35 women with vascular RPOC, 30 (86%) presented with vaginal bleeding at a visit, and 6 (17%) required inpatient management due to heavy bleeding. Among women who presented with vaginal bleeding, serum progesterone levels were significantly lower (0.25 vs. 6.5 ng/mL, p = 0.004) than those in women who did not present with vaginal bleeding. There were no differences in serum hCG levels (10.5 vs. 3.1 mIU/mL) or serum estradiol levels (65.4 vs. 162.3 pg/mL). After withdrawal bleeding following the first course of EPT, vaginal bleeding was stopped in 27 of the 30 women (90%), and 23 (66%) of all women had a thin and linear endometrium. All women could be treated by up to two courses of EPT and did not require additional interventions. The median duration to hCG normalization after the initial EPT was 24.5 (9-88) days.
Women with vascular RPOC who have no bleeding had significantly higher levels of serum progesterone, indicating that administration of progestogen may have an effect on hemostasis. Endometrial bleeding can be prevented or stopped, and retained tissues can be conservatively expelled by oral administration of EPT, including norethisterone, in women with vascular RPOC.
评估流产或堕胎后发生血管性妊娠物残留（RPOC）的女性的临床特征和内分泌背景，并根据内分泌背景评估雌激素-孕激素治疗（EPT）作为初始治疗对此类人群的效果。
回顾性分析了 35 例妊娠 20 周内流产或堕胎后发生血管性 RPOC 并接受 EPT（结合雌激素和炔诺酮）治疗的患者。评估了她们的临床特征、激素参数、超声表现和结局。
35 例血管性 RPOC 患者中，30 例（86%）就诊时有阴道出血，6 例（17%）因大出血需要住院治疗。有阴道出血的患者血清孕激素水平显著低于无阴道出血的患者（0.25 与 6.5 ng/mL，p = 0.004）。两组患者的血清 hCG 水平（10.5 与 3.1 mIU/mL）或血清雌二醇水平（65.4 与 162.3 pg/mL）均无差异。首次 EPT 撤退性出血后，30 例有阴道出血的患者中 27 例（90%）阴道出血停止，所有患者的子宫内膜均变薄呈线状。所有患者均可接受最多两个疗程的 EPT 治疗，无需进一步干预。初始 EPT 后 hCG 正常化的中位时间为 24.5（9-88）天。
无出血的血管性 RPOC 患者血清孕激素水平显著升高，提示孕激素的应用可能具有止血作用。口服 EPT（包括炔诺酮）可预防或停止子宫内膜出血，并保守性排出残留组织。
