To evaluate the clinical features of women with vascular retained products of conception (RPOC) following delivery and to assess the efficacy of estrogen-progestogen therapy (EPT) as an initial intervention for this group.

A retrospective study was conducted of women with vascular RPOC after delivery at ≥ 20 weeks gestation who received EPT (combination of conjugated estrogen and norethisterone) between 2017 and 2023. Clinical characteristics, hormonal levels, ultrasonographic assessments, and treatment outcomes were analyzed.

A cohort of 21 women with vascular RPOC following delivery was identified. The median interval from delivery to initial hospital consultation was 48 days (IQR: 33-50), with five patients requiring inpatient care due to substantial bleeding. Among the 21 patients, 18 received EPT. Following the first course of EPT and subsequent withdrawal bleeding, 17 (94%) showed resolution of vascularity on color Doppler, and 11 (61%) exhibited a linear endometrial pattern. All patients completed treatment within two EPT courses, with no need for further intervention. The median time to human chorionic gonadotropin normalization from EPT initiation was 14 days (IQR: 3-25).

EPT incorporating norethisterone appears effective in attenuating and eliminating endometrial blood flow in women with vascular RPOC after delivery, facilitating intrauterine tissue expulsion without additional treatments.

This editorial discusses the case report by Kakinuma et al, which details a rare occurrence of uterine artery pseudoaneurysm following hysteroscopic surgery. The case highlights diagnostic challenges and management strategies for this uncommon complication. The editorial explores the implications for clinical practice, emphasizing the importance of early recognition and appropriate intervention to prevent potential severe outcomes. Future research directions to increase the understanding and management of uterine artery pseudoaneurysm in similar clinical settings.

Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of < 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.

A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency > 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient's condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection.

After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient's condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient's successful recovery.

Uterine artery pseudoaneurysm (UAP) is a rare disease that causes genital bleeding during the postpartum period after cesarean section. Uterine artery embolization (UAE) is an effective procedure for UAP. UAP was unexpectedly encountered in a patient with gestational trophoblastic disease; however, this patient was conservatively managed without UAE. UAP can occur during treatment for gestational trophoblastic disease. Since asymptomatic UAP may spontaneously disappear, in the selection of conservative treatment, it is important to carefully monitor patients using transvaginal ultrasonography focusing on the size of the UAP and the speed of internal blood flow.