Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion
Objective: 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 endocr...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Taiwanese Journal of Obstetrics & Gynecology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1028455923001791 |
| _version_ | 1797690940022849536 |
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| author | Munekage Yamaguchi Akiho Nishimura Takeshi Motohara Takashi Ohba Eiji Kondoh |
| author_facet | Munekage Yamaguchi Akiho Nishimura Takeshi Motohara Takashi Ohba Eiji Kondoh |
| author_sort | Munekage Yamaguchi |
| collection | DOAJ |
| description | Objective: 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. Materials and methods: 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. Results: 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. Conclusion: 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. |
| first_indexed | 2024-03-12T02:07:21Z |
| format | Article |
| id | doaj.art-920eba4fecc54099aaff83c817b491d5 |
| institution | Directory Open Access Journal |
| issn | 1028-4559 |
| language | English |
| last_indexed | 2024-03-12T02:07:21Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Taiwanese Journal of Obstetrics & Gynecology |
| spelling | doaj.art-920eba4fecc54099aaff83c817b491d52023-09-07T04:43:02ZengElsevierTaiwanese Journal of Obstetrics & Gynecology1028-45592023-09-01625661666Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortionMunekage Yamaguchi0Akiho Nishimura1Takeshi Motohara2Takashi Ohba3Eiji Kondoh4Corresponding author. Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto-City, Kumamoto 860-8556, Japan. Fax: +81 96 363 5164.; Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, JapanDepartment of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, JapanDepartment of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, JapanDepartment of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, JapanDepartment of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, JapanObjective: 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. Materials and methods: 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. Results: 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. Conclusion: 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.http://www.sciencedirect.com/science/article/pii/S1028455923001791Abnormal uterine bleedingEstrogen breakthrough bleedingNorethisteroneWithdrawal bleeding |
| spellingShingle | Munekage Yamaguchi Akiho Nishimura Takeshi Motohara Takashi Ohba Eiji Kondoh Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion Taiwanese Journal of Obstetrics & Gynecology Abnormal uterine bleeding Estrogen breakthrough bleeding Norethisterone Withdrawal bleeding |
| title | Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion |
| title_full | Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion |
| title_fullStr | Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion |
| title_full_unstemmed | Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion |
| title_short | Efficacy of estrogen–progestogen therapy for women with vascular retained products of conception following miscarriage or abortion |
| title_sort | efficacy of estrogen progestogen therapy for women with vascular retained products of conception following miscarriage or abortion |
| topic | Abnormal uterine bleeding Estrogen breakthrough bleeding Norethisterone Withdrawal bleeding |
| url | http://www.sciencedirect.com/science/article/pii/S1028455923001791 |
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