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Predictive factors for massive hemorrhage in women with retained products of conception: a prospective study.

ABSTRACT: Retained products of conception (RPOC) is a common cause of postpartum bleeding, which may be life-threatening; however, no evidence-based guidelines exist to assist in evaluating the risk of massive hemorrhage in women with RPOC. In this prospective study, we aimed to evaluate the predictive factors for massive hemorrhage in women with RPOC. The primary and secondary endpoints were to validate the usefulness of power Doppler color scoring (PDCS) in evaluating hypervascularity and to identify other predictive factors (such as maximum RPOC diameter and serum βhCG and Hb level at first visit), respectively. Among the 51 women with RPOC included in this study, 16 (31.5%) experienced massive hemorrhage during follow-up. None of the women with PDCS 1 or 2 (18) experienced massive hemorrhage, whereas 16 (48.5%) women with PDCS 3 or 4 (33) did. Multiple logistic regression analysis showed that the odds ratio [95% confidence interval] (P value) for PDCS, assisted reproductive technology (ART), and low serum hemoglobin (Hb) levels were 22.39 [2.25 - 3087.92] (P = 0.004), 5.72 [1.28 - 33.29] (P = 0.022), and 4.24 [0.97 - 22.99] (P = 0.056), respectively. Further, the decision tree method identified PDCS, ART, and low serum Hb levels as potential predictive factors for massive hemorrhage. This study identified PDCS as useful predictor of massive hemorrhage in women with RPOC. With additional inclusion of factors such as ART and low serum Hb levels, the risk of massive hemorrhage may be effectively evaluated, leading to better management of women of reproductive age.

SUBMITTER: Sonehara R

PROVIDER: S-EPMC9279309 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionNumerous studies have been performed assessing optimal treatment regimens for evacuating (retained) products of conception from the uterus, but standardized criteria for diagnosing retained products of conception (RPOC) are still lacking. We aim to provide an overview of diagnostic criteria in current literature, used to diagnose RPOC after induced first-trimester abortion or early pregnancy loss.Material and methodsPubmed, EMBASE, and the Cochrane library were searched systematically up until March 2020 for English articles reporting on induced abortion or early pregnancy loss. Articles not specifying diagnostic criteria used to assess completeness of treatment were excluded, as were conference abstracts, expert opinions, reviews, and case reports. Four elements of diagnostic criteria were described: diagnostic tools, parameters used within these tools, applied cut-off values, and timing of follow up. Additionally, a meta-analysis was performed assessing diagnostic qualities of the most often applied diagnostic tool and parameter.ResultsThe search strategy yielded 1233 unique articles, of which 248 were included, with a total of 339 517 participants. In the 79 included randomized controlled trials, six diagnostic tools to assess RPOC were identified, combined in 14 ways, with 55 different cut-off values. In 169 observational studies, seven diagnostic tools were identified, used in 28 combinations, applying 89 different cut-off values. Transvaginal ultrasonographic measurement of endometrial thickness with a cut-off value of at least 15 mm indicating RPOC, was used most frequently. In the timing of follow-up there was great variation, with 55 and 107 different combinations in randomized controlled trials and observational studies, respectively. Assessment of treatment success was scheduled most often around 2 weeks after treatment. Diagnostic qualities of endometrial thickness of 15 mm or more was not adequately assessed.ConclusionsThere is wide variation in the way RPOC are assessed, and the criteria used to define RPOC following induced abortion and early pregnancy loss; ultrasonographic measurement of endometrial thickness, with a cut-off of 15 mm or more 2 weeks after primary treatment is the most widely used diagnostic approach. A meta-analysis on diagnostic accuracy of endometrial thickness of 15 mm or more did not lead to solid results. These findings can be a first step to develop a workable standard of establishing RPOC after induced abortion or early pregnancy loss.

Project description:ObjectivesPregnancy-related lumbopelvic pain (LPP) is a frequent condition known to significantly affect women in their daily life. The aetiology of pregnancy-related LPP pain is still not clearly established but the mode of conception has been suggested to contribute to LPP. Anxiety related to fertility treatments may be one of the contributing factors. The primary objectives of this study were to determine the evolution of LPP prevalence and severity, and anxiety throughout pregnancy in women who conceived spontaneously (SP) or after fertility treatments (FT). A further aim was to examine the relationship between pregnancy-related LPP severity and anxiety. The secondary objective was to determine the evolution of physical activity and their correlation with the severity of pregnancy-related LPP.DesignProspective cohort study.SettingPregnant women were recruited through physicians' referrals, posters and newspaper advertisements in the local and surrounding communities (hospital, maternity care clinic, prenatal centres, sports centres, local university) in the city of Trois-Rivières, Canada.Participants59 pregnant women (33 SP and 26 FT) were assessed during the first, second and third trimester of pregnancy.Primary and secondary outcome measuresPregnancy-related LPP prevalence and severity (primary), trait and state anxiety, and physical activity levels (secondary).ResultsThere was no relationship between the mode of conception and the outcome measures. The prevalence and severity of LPP increased over the course of pregnancy (time effect, p<0.0001) whereas trait anxiety decreased from early to mid-pregnancy (time effect, p=0.03). Activity limitations increased throughout pregnancy (time effect, p<0.0001) and physical activity levels decreased (time effect, p<0.0001). The severity of LPP was positively correlated with activity limitations (r=0.51?to 0.55) but negatively with physical activity levels (r=-0.39?to -0.41).ConclusionsMaternal health-related factors, such as LPP, anxiety and physical activity, are not different in women who conceived spontaneously or after fertility treatments. The more LPP was severe, the more the women were physically limited and inactive.

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Predictive factors for massive hemorrhage in women with retained products of conception: a prospective study.

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