Uterine artery embolization for secondary postpartum hemorrhage due to retained products of conception, a case series

Abstract

Retained products of conception (RPOC) are the most common cause of secondary postpartum hemorrhage (PPH). We present two cases of RPOC following vaginal delivery, each presenting with secondary PPH after earlier primary PPH. MRI is instrumental in confirming the diagnosis of RPOC, excluding placenta accreta spectrum and presumably uterine arteriovenous malformation. In both cases, digital subtraction angiography (DSA) demonstrated intrauterine vascular lesions without early venous drainage, excluding arteriovenous malformation and confirming the diagnosis of RPOC. The vascular pattern observed via DSA of the uterus and RPOC is reproducible on MRI. Understanding the imaging features of RPOC and alternative diagnoses via both MRI and DSA are essential for accurate diagnosis and treatment. Both patients were successfully treated with uterine artery embolization using a commercially presized gelatin sponge, which is a safe and effective treatment for secondary PPH due to RPOC.