Diagnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception.

OBJECTIVES: To assess the complication rate, including estimated amount of blood loss, in patients undergoing dilation and curettage (D&C) for the treatment of retained products of conception with markedly enhanced myometrial vascularity mimicking arteriovenous malformation. METHODS: This was a retrospective medical-records review study of patients with retained products of conception with enhanced myometrial vascularity presenting to our ultrasound unit between August 2015 and August 2017. Color/power Doppler imaging was used subjectively to identify the degree and extent of vascularity. All patients underwent D&C, and their operative reports and medical records were reviewed to see if ultrasound guidance was used, to ascertain estimated blood loss and to identify complications during or after the procedure. RESULTS: The study group included 31 patients, of whom seven had retained products of conception after a vaginal delivery and 24 had retained products of conception after a first-trimester termination or miscarriage. The largest dimension of the region of enhanced myometrial vascularity ranged from 10 mm to 53 mm, with 14/31 having a width of ≥ 20 mm. Fifteen patients underwent a standard D&C procedure, 13 an ultrasound-guided procedure and three hysteroscopy. Estimated operative blood loss varied from negligible to a maximum of 400 mL. There were no intraoperative complications, although one patient was treated for presumed endometritis. CONCLUSIONS: An increasing number of studies describe the enhanced myometrial vascularity associated with retained products of conception as 'acquired arteriovenous malformation', with some recommending management with uterine-artery embolization. Our study demonstrates that the enhanced myometrial vascularity is associated with retained products of conception, and surgical removal by D&C, possibly with the aid of ultrasound guidance or hysteroscopy, is a safe treatment option. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Screening for depression in stroke: relationship to rehabilitation efficiency.

Depression is common after stroke but is often not diagnosed. Its presence may impair progress during rehabilitation and limit functional improvement after discharge. We investigated the use of the Geriatric Depression Scale (GDS) to screen for depression among acute stroke patients. All stroke patients in an acute rehabilitation hospital who were referred for assessment of cognitive deficits were also screened for depression with the GDS. By using a modified cutoff score to account for items that could reflect physical effects of the stroke rather than depression, 22% of patients screened were classified as depressed. The rate of depression was higher among women (36%) than men (10%). Patients with elevated GDS scores (> or =15) stayed in the hospital an average of 5.76 days longer than patients whose scores fell below this cut-off. Higher GDS scores were also associated with less efficient use of rehabilitation services as measured by the Functional Independence Measure. Screening stroke patients for depression at the time of admission to rehabilitation may identify individuals at risk to progress more slowly, may initiate more comprehensive assessment, and, if appropriate, may initiate rapid intervention.