Evaluation of Treatment Appropriateness for Secondary Postpartum and Post-Abortion Hemorrhage Due to Uterine Vascular Anomalies

Secondary postpartum and post-abortion hemorrhage caused by uterine vascular anomalies can vary in severity from mild to life-threatening. Despite the availability of multiple treatment options, there has been no systematic evaluation of their appropriateness across different clinical situations. This study aimed to evaluate the suitability of treatments for secondary postpartum and post-abortion hemorrhage based on hypothetical scenarios that incorporate various clinical presentations and imaging findings related to uterine vascular anomalies.

Using the RAND/UCLA appropriateness method, a panel of 14 French experts in gynecology and diagnostic and interventional radiology assessed the appropriateness of various treatments for secondary postpartum and post-abortion hemorrhage. They also evaluated terminology and the diagnostic usefulness of color Doppler ultrasound and MRI.

The results of the study demonstrated:

The study included 290 clinical scenarios, among which 36 (12.4%) were deemed appropriate, while 137 (47.2%) were considered inappropriate.
For patients presenting with extensive enhanced myometrial vascularity (EMV) adjacent to hypervascular retained products of conception (RPOC), embolization with gelfoam—either alone or followed by curettage or operative hysteroscopy—was rated as appropriate.
For patients with limited EMV and RPOC, the same treatment approach was also deemed suitable.
In instances where EMV was present without RPOC, embolization with gelfoam was considered appropriate for managing significant or recurrent bleeding that leads to anemia.

In summary, these recommendations, which take into account clinical presentations, imaging findings, and the patient’s pregnancy plans, provide valuable guidance for gynecologists and radiologists in managing uterine vascular anomalies following postpartum and post-abortion events.

Source: Barral, PA et al. Appropriateness of treatments for postpartum and post-abortion uterine vascular anomalies. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2025. https://www.ejog.org/article/S0301-2115(25)00111-3/abstract

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