Conservative management of enhanced myometrial vascularity (EMV) after a first trimester miscarriage or termination of pregnancy: a retrospective cohort study

To evaluate the spontaneous resolution time, need for rehospitalization or surgical management during conservative management in women diagnosed with Enhanced Myometrial Vascularity (EMV) after first-trimester miscarriage or termination of pregnancy (TOP) and to evaluate the different evolution between women with or without associated retained products of conception (RPOC). Retrospective cohort study conducted at Azienda Ospedaliero-Universitaria di Modena and including all women with a sonographic diagnosis of EMV (with/without RPOC) between January 2021 and August 2024. All patients were managed conservatively with serial follow-up ultrasound (US) scans till the sonographic resolution of the EMV. Some women were immediately prescribed with different oral hormonal therapies (HT) during follow-up. Chi-squared test and Fisher's exact test were used as appropriate adopting a p-value less than 0.05 for significance. 31 women with EMV were included; overall, 29/31(93.5%) were followed up by US only until spontaneous disappearance of the EMV. Two women required additional procedures. No differences were found in terms of: mean time of resolution (97.6 vs. 66.2 days, p = 0.20), re-admission for bleeding (37.5% vs. 20.8%, p = 0.35), need for transfusion (12.5% vs. 4.2%, p = 0.40) and Emergency-Room access for bleeding (25% vs. 20.8%, p = 0.81) during follow-up between patients with RPOC associated with EMV vs. isolated EMV. Results were similar comparing women who had an immediate prescription of HT vs. women not receiving HT. Hemodynamically stable patients with US diagnosis of EMV can be managed conservatively with serial US follow-ups; HT can be prescribed immediately without increasing the risk of complications in these women.