International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Comparative effectiveness of curettage, uterine artery embolization, and gonadotropin-releasing hormone (GnRH) agonist therapy in the management of acquired uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) and retained products of conception (RPOC): A retrospective cohort study.
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Foroughi Amin Abolhasani, Dehghani Seyed Sina, Shiravani Zahra, Mansoori Mehran
Аннотация
OBJECTIVE: To compare the effectiveness of curettage, uterine artery embolization (UAE), and gonadotropin-releasing hormone (GnRH) agonist therapy in the management of post-abortion acquired uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) with retained products of conception (RPOC), focusing on short-term healing and reproductive outcomes.
METHODS: This monocentric retrospective cohort study included 159 women with EMV/AVM associated with RPOC after abortion, treated at a tertiary referral center affiliated with Shiraz University of Medical Sciences between January 2022 and December 2025. Patients underwent curettage, UAE with polyvinyl alcohol (PVA) particles, or GnRH agonist therapy. Outcomes included EMV/AVM healing and RPOC resolution at 4 weeks, change in RPOC volume, subsequent pregnancy, and recurrent abortion. Analyses were performed in SPSS version 26.0 with a two-sided significance threshold of P less than 0.05, following STROBE guidelines.
RESULTS: At 4 weeks, AVM healing occurred in 70.2% and RPOC resolution in 68.4% of patients. Curettage and UAE achieved significantly higher rates of EMV/AVM and RPOC healing than GnRH agonist therapy (P = 0.018 and P = 0.013, respectively). No significant between-group differences were observed for subsequent pregnancy (P = 0.933) or recurrent abortion (P = 0.065).
CONCLUSION: Curettage and UAE provide superior short-term healing compared with GnRH agonist therapy, while reproductive outcomes appear comparable across modalities. Treatment selection should consider Doppler parameters, clinical stability, and fertility goals.
METHODS: This monocentric retrospective cohort study included 159 women with EMV/AVM associated with RPOC after abortion, treated at a tertiary referral center affiliated with Shiraz University of Medical Sciences between January 2022 and December 2025. Patients underwent curettage, UAE with polyvinyl alcohol (PVA) particles, or GnRH agonist therapy. Outcomes included EMV/AVM healing and RPOC resolution at 4 weeks, change in RPOC volume, subsequent pregnancy, and recurrent abortion. Analyses were performed in SPSS version 26.0 with a two-sided significance threshold of P less than 0.05, following STROBE guidelines.
RESULTS: At 4 weeks, AVM healing occurred in 70.2% and RPOC resolution in 68.4% of patients. Curettage and UAE achieved significantly higher rates of EMV/AVM and RPOC healing than GnRH agonist therapy (P = 0.018 and P = 0.013, respectively). No significant between-group differences were observed for subsequent pregnancy (P = 0.933) or recurrent abortion (P = 0.065).
CONCLUSION: Curettage and UAE provide superior short-term healing compared with GnRH agonist therapy, while reproductive outcomes appear comparable across modalities. Treatment selection should consider Doppler parameters, clinical stability, and fertility goals.