Vascular Retained Products of Conception Following Delivery: Efficacy of Estrogen–Progestogen Therapy

ABSTRACT Objective 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. Methods 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. Results 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). Conclusion 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.