Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm with intermediate biologic potential that rarely involves the female genital tract. Distinguishing IMT from other pelvic spindle cell tumors can be challenging, particularly in patients with a prior history of uterine smooth muscle neoplasms. We report a 59-year-old woman who underwent hysterectomy for a smooth muscle tumor of uncertain malignant potential and presented 8 years later with recurrent small bowel obstruction and right flank pain. Imaging revealed a large infiltrative pelvic mass involving ovaries, ureter, small bowel, peritoneum, and iliac vessels. She underwent extensive multidisciplinary surgery, including small bowel resection, right nephrectomy, and vascular reconstruction. Histopathologic examination demonstrated a fascicular proliferation of spindle cells associated with a prominent lymphoplasmacytic inflammatory infiltrate. Diffuse anaplastic lymphoma kinase (ALK) expression was identified by immunohistochemistry, and fluorescence in situ hybridization demonstrated an ALK rearrangement, supporting the diagnosis of ALK-positive IMT. Identification of the ALK rearrangement directly influenced treatment selection and enabled initiation of ALK-targeted therapy. This case highlights the diagnostic challenges posed by pelvic spindle cell neoplasms in a patient with a history of uterine smooth muscle neoplasms and underscores the importance of integrating morphologic, immunohistochemical, and molecular findings to establish an accurate diagnosis and guide targeted therapy.
Chronic histiocytic intervillositis (CHI) is a rare placental disorder linked to poor pregnancy outcomes, including fetal growth restriction and perinatal loss. We report a case of recurrent CHI in a 36-year-old woman with five previous pregnancy losses. In her sixth pregnancy, placental histology confirmed CHI after preterm delivery. In a subsequent seventh pregnancy, despite early treatment with aspirin, low-molecular weight heparin, and hydroxychloroquine, she developed uteroplacental dysfunction at 17 weeks with hypertension, proteinuria, and transaminitis. Rescue therapy with high-dose prednisolone led to maternal clinical improvement, stabilization of fetal Dopplers, and pregnancy prolongation to 30 weeks. Placental histology showed a reduced inflammatory infiltrate compared to the prior pregnancy, suggesting a therapeutic effect from corticosteroids. This case reports the novel use of high-dose corticosteroid rescue therapy in managing CHI and highlights the importance of early diagnosis, multidisciplinary care, and the need for further research.
AIM:We compared outcomes and toxicities of weekly paclitaxel plus carboplatin-based (wTC) and cisplatin-based (CDDP) concurrent chemoradiotherapy (CCRT) in FIGO stage IB2-IVA cervical cancer cases. METHODS:We retrospectively reviewed patients with FIGO stage IB2-IVA cervical cancer who underwent definitive-intent CCRT at our institution between 2009 and 2024. To reduce temporal confounding, the primary analysis was restricted to 2015-2024, when both regimens were available, and a sensitivity analysis included the entire period. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method and Cox proportional hazards models. RESULTS:The primary analysis included 54 patients (wTC, n = 27; CDDP, n = 27). Baseline characteristics were balanced. The 3-year PFS rates were 53.5% and 77.4% in the wTC and CDDP groups, respectively (p = 0.078), and the 3-year OS rates were 76.4% and 75.4%, respectively (p = 0.882). The treatment regimen was not significantly associated with OS, whereas tumor diameter ≥ 6 cm was associated with worse OS. In the sensitivity analysis (wTC, n = 84; CDDP, n = 27), PFS and OS did not differ significantly between groups. Creatinine increased was more severe in the CDDP group, whereas neutropenia was more severe in the wTC group. CONCLUSIONS:No significant differences in survival outcomes were observed between wTC-CCRT and CDDP-CCRT in patients with FIGO stage IB2-IVA cervical cancer. The study was not designed to establish equivalence or non-inferiority. wTC-CCRT may be considered for selected patients unable to receive cisplatin, although its comparative efficacy remains uncertain.
AIM:The current meta-analysis aims to assess the incidence of isolated maternal hypothyroxinemia (IMH) and its impact on pregnancy complications and adverse pregnancy outcomes. METHODS:PubMed, Embase, Web of Science, and Cochrane databases were searched until November 15, 2024. Cochrane, a risk-of-bias assessment tool, was used to evaluate the quality of literature; R Studio and Stata 15.0 were employed for data analysis and publication bias assessment. RESULTS:In total, 22 cohort studies were analyzed, with a sample size of 33,1640 cases, including 16 390 IMH patients. The meta-analysis revealed that the prevalence of IMH was 5.7% (95% CI: 3.5, 8.4%). Compared to pregnant women with normal thyroid function, the prevalence of gestational diabetes mellitus (GDM) in IMH patients was 1.12% (95% CI: 1.01,1.24), macrosomia was 1.41% (95% CI: 1.12, 1.65), preterm birth was 1.26% (95% CI: 1.12, 1.41), and preeclampsia/eclampsia was 1.26% (95% CI: 1.12, 1.41) (p < 0.05). CONCLUSIONS:Patients with IMH have an elevated risk of GDM, preeclampsia, eclampsia, preterm birth, and macrosomia relative to normal pregnant women. It is anticipated that future studies will further confirm the complications related to pregnancy in patients with IMH.
AIM:To provide information including the trend of gynecological malignancies in Japan, we hereby present the Annual Patient Report for 2023 and the Annual Treatment Report for 2018 on the outcomes of patients who started treatment in 2018. METHODS:The Japan Society of Obstetrics and Gynecology maintains an annual tumor registry, where information on gynecological malignancies from various participating institutions is gathered. The data of patients whose treatment with gynecologic malignancies was initiated in 2023 were analyzed retrospectively. Survival of the patients who started treatment with cervical, endometrial, and ovarian cancer in 2018 was analyzed by using the Kaplan-Meier, log-rank, and Wilcoxon tests. RESULTS:Treatment was initiated in 2023 for 8061 patients with cervical cancer, 15 455 with endometrial cancer, 8844 with ovarian, tubal, and peritoneal cancer, 2316 with ovarian borderline tumors, and with the others (230 vulvar cancer, 157 vaginal cancer, 533 uterine sarcoma, 54 uterine adenosarcoma, 132 trophoblastic diseases). This clinicopathological information was summarized as the Patient Annual Report. The 5-year survival rates of the patients who initiated treatment in 2018 were as follows. For cervical cancer, the rates were 92.6%, 75.7%, 57.3%, and 25.9% for Stages I, II, III, and IV, respectively. For endometrial cancer, the rates were 94.3%, 88.3%, 75.2%, and 32.1% for Stages I, II, III, and IV, respectively. For ovarian cancer, the rates were 90.9%, 79.2%, 53.4%, and 41.1% for Stages I, II, III, and IV, respectively. CONCLUSION:The annual tumor report is an important survey that provides knowledge on gynecological malignancy trends in Japan.
AIM:To clarify the clinical characteristics, diagnostic course, and presumed etiologies of severe cerebral palsy associated with perinatal cerebral infarction, and to compare cases in which cerebral infarction was diagnosed during and after the neonatal period. METHODS:This retrospective registry-based study used data from the Japan Obstetric Compensation System for Cerebral Palsy between 2009 and 2022. Severe cerebral palsy cases associated with cerebral infarction were identified. The clinical characteristics and diagnostic courses of cerebral infarction were evaluated and compared between neonatally diagnosed cases and post-neonatally diagnosed cases. RESULTS:Of the 85 cases of cerebral infarction analyzed, neonatally diagnosed cases accounted for 40 (47.1%) and post-neonatally diagnosed cases for 44 (51.8%); 1 case was diagnosed prenatally. Neonatal diagnosis was more frequently triggered by seizures, apnea, respiratory distress, or neuroimaging during NICU hospitalization, whereas most post-neonatal diagnoses followed recognition of motor impairment. Neonatally diagnosed cases more frequently exhibited a non-reassuring fetal status, lower umbilical artery pH, lower Apgar scores, and neonatal asphyxia. However, no significant differences were observed in median age at the recognition of motor impairment (7 months in both groups) or severe brain injury findings between neonatally and post-neonatally diagnosed cases. Potential contributing conditions were identified in 15.3% of cases. CONCLUSIONS:Similar timing of motor impairment recognition and frequency of severe brain injury findings between the two groups may suggest that differences in cerebral infarction diagnostic timing may primarily reflect different clinical triggers for neuroimaging. The etiology and timing of infarction onset remained unclear in many cases.
AIM:To evaluate menstrual recovery, reproductive outcomes, and survival following fertility-sparing surgery and platinum-based chemotherapy in women with malignant ovarian germ cell tumors (MOGCTs). METHODS:We retrospectively reviewed women aged 15-40 years with MOGCT treated at a university hospital (2001-2012). All underwent fertility-sparing surgery and platinum-based chemotherapy. Menstrual and reproductive outcomes were assessed through structured interviews and compared with age-matched controls. Survival outcomes were analyzed by Kaplan-Meier method. RESULTS:Among 1934 ovarian cancer cases, 209 (10.8%) were MOGCT; 44 patients met inclusion criteria and were matched to 44 controls. Median age was 21 years; dysgerminoma was the most common histology (40.9%), and 70.4% had Stage I disease. All received bleomycin, etoposide, and cisplatin (median 4 cycles). After a median follow-up of 55 months, 97.7% resumed menstruation. Compared with baseline and controls, cycles were shorter (4 vs. 5 days, p = 0.026), lighter (2 vs. 3 pads/day, p = 0.004-0.047), and longer in interval (29.2 vs. 26.4 days, p < 0.001). Of 17 patients attempting conception, 9 achieved 10 pregnancies, with a pregnancy rate of 52.9% and live-birth rate of 90.9%, without congenital anomalies. Only one recurrence occurred, with 10-year progression-free and overall survival of 95.3% and 97.9%, respectively. CONCLUSIONS:Fertility-sparing surgery followed by platinum-based chemotherapy was associated with excellent long-term survival, high rates of menstrual recovery, and favorable reproductive outcomes in young women with MOGCT. These findings support current international recommendations for fertility-preserving treatment in selected patients and provide long-term evidence from a Southeast Asian cohort.
Leptomeningeal metastasis (LM) is a rare complication of cervical cancer associated with a poor prognosis. We report a 61-year-old woman with stage IVB cervical squamous cell carcinoma who developed acute headache and diplopia during systemic chemotherapy. Brain magnetic resonance imaging suggested LM, which was confirmed by cerebrospinal fluid (CSF) cytology. An Ommaya reservoir was inserted, and intrathecal methotrexate therapy was initiated. The patient showed rapid neurological improvement, normalization of CSF opening pressure, and sustained clearance of malignant cells on serial CSF cytology. Although systemic disease subsequently progressed, LM-related neurological symptoms remained well controlled. The patient survived for 8 months after LM diagnosis. This case highlights the importance of considering LM in cervical cancer patients with new neurological symptoms and suggests that intrathecal chemotherapy via an Ommaya reservoir may provide effective neurological control and symptomatic relief.
Atypical superimposed preeclampsia (sPE) developing before 20 weeks of gestation is extremely rare, and its pathophysiology remains unclear. We herein report three women with underlying chronic hypertension or IgA nephropathy who developed severe hypertension, worsening proteinuria, and fetal growth restriction or fetal death before 20 weeks of gestation. All cases showed markedly elevated soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratios (617-1357), and placental pathology demonstrated maternal vascular malperfusion. Maternal clinical manifestations promptly improved after the termination of pregnancy. All three women subsequently achieved successful pregnancies with appropriate management. These results suggest that atypical sPE shares the angiogenic imbalance and placental pathology characteristic of conventional preeclampsia. Although limited by the small number of cases, these results provide additional insights into the pathophysiology of atypical sPE and suggest a role for angiogenic biomarkers in evaluating placental dysfunction.
BACKGROUND:High-risk HPV screening achieves high sensitivity but low specificity, resulting in excessive colposcopy referrals. DNA methylation biomarkers could refine risk stratification across the cervical cancer care continuum. OBJECTIVE:To evaluate the diagnostic performance and clinical implementation of DNA methylation testing in HPV-positive triage and post-treatment surveillance. METHODS:Narrative review of prospective cohorts and randomized trials (2013-2024) evaluating methylation markers in cervical cancer screening and monitoring. RESULTS:The FAM19A4/miR124-2 panel demonstrated sensitivity/specificity of 0.83/0.90 for CIN3+ in HPV-positive women, reducing colposcopy referrals by 45% while maintaining < 3% missed CIN3+. In post-treatment surveillance, plasma cell-free DNA (cfDNA) methylation may enable earlier recurrence detection than imaging (sensitivity 0.81, specificity 0.93, based on limited prospective data). A proposed three-step conceptual framework integrating methylation testing across screening, postoperative assessment, and recurrence monitoring is presented as a hypothesis-generating model requiring prospective validation. CONCLUSIONS:DNA methylation testing shows promise for clinical implementation in HPV triage and post-treatment surveillance. Evidence remains fragmented across separate studies. Standardization of thresholds and cost reduction are priorities for guideline inclusion.
AIM:To map and characterize the available evidence on podcasts addressing topics related to women's health. METHODS:This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines. A comprehensive search was carried out in 12 databases in November 2025. Quantitative and qualitative studies addressing podcasts related to women's health were included, with no restrictions on publication date or language. The review protocol was registered on the Open Science Framework (https://osf.io/7p9yr/overview). The results are reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). RESULTS:A total of 37 studies were included, primarily targeting health professionals and students (n = 15). Thematic analysis showed that gynecology was the most frequent category (48.6%), with subthemes focusing on the climacteric (n = 6), breast cancer (n = 4), and fertility (n = 3). Breastfeeding and healthy lifestyle shared second place (18.9% each), emphasizing lactation challenges and physical activity/nutrition, respectively. Obstetrics (13.5%) addressed labor and postpartum recovery, while motherhood (8.1%) explored maternal guilt. Finally, miscellaneous themes (16.2%) covered mental health, chronic diseases, and maternal mortality. CONCLUSION:Podcasts have emerged as a versatile and strategic tool for health education and self-care promotion throughout the female life cycle. While widely used for professional training and patient empowerment, there is a critical need for rigorous content curation and evidence-based production to mitigate the risks of misinformation. Future research should focus on validating these digital tools and evaluating their long-term impact on clinical outcomes and health literacy.
AIM:Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder, and the independent effect of exercise as a fundamental intervention for it remains to be clarified. Therefore, this study aimed to examine the effect of exercise intervention alone on improving reproductive endocrine and metabolic profiles in individuals with PCOS. METHODS:A systematic search of multiple databases was conducted for randomized controlled trials (RCTs) published until July 2025. Data from eligible RCTs were collected, and quality evaluation with meta-analysis was performed. RESULTS:This investigation encompassed 22 RCTs involving 1044 women with PCOS. The meta-analysis indicated that exercise significantly reduced total testosterone (TT), free testosterone, fasting insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), while increasing high-density lipoprotein levels. Subgroup analyses showed that moderate-to-low intensity exercise specifically increased sex hormone-binding globulin. Exercise duration ≥ 150 min per week yielded more pronounced reductions in TT. Concerning population characteristics, Asian cohorts exhibited particularly prominent improvements in reducing body mass index, TT, low-density lipoprotein, fasting insulin, and HOMA-IR. South American and European populations showed significant benefits in lowering TT and fasting insulin, respectively. Moreover, non-obese women with PCOS experienced greater reductions in TT compared to their obese counterparts. CONCLUSIONS:Exercise intervention alone significantly ameliorates body composition, hyperandrogenism, and certain glucose and lipid metabolic disturbances in individuals with PCOS. The benefits are modulated by exercise parameters (intensity, weekly duration) and baseline patient characteristics (geographical distribution, obesity status), highlighting the importance of individualized interventions in clinical practice.
AIM:Increasingly, point-of-care testing has been adopted to rapidly assess fibrinogen levels for managing severe postpartum hemorrhage; however, evidence regarding its impact on clinical outcomes is limited. We evaluated whether implementing a transfusion strategy guided by point-of-care testing was associated with changes in blood loss and transfusion outcomes in patients with severe postpartum hemorrhage. METHODS:We conducted a retrospective single-center interrupted time series analysis at a tertiary perinatal referral center in Japan. Consecutive patients with severe postpartum hemorrhage (blood loss, ≥ 1000 mL) requiring emergency transfer between April 2014 and March 2019 were included. A dry hematology-based point-of-care testing system combined with a standardized transfusion protocol was introduced in March 2016. The primary outcome was total blood loss. Secondary outcomes included transfusion volumes and in-hospital maternal mortality. Segmented regression models were used to estimate changes in level and trend before and after implementation. RESULTS:Among 142 patients included (52 before and 90 after intervention implementation), baseline severity indicators were higher in the pre-intervention period. Implementation of the point-of-care testing-guided transfusion strategy was not associated with significant changes in total blood loss or volumes of red blood cells or fresh frozen plasma transfused. Similar findings were observed for in-hospital outcomes. Results were consistent across the adjusted and sensitivity analyses. CONCLUSIONS:Implementing a point-of-care testing-guided transfusion strategy was not associated with significant improvements in blood loss or transfusion outcomes among patients with severe postpartum hemorrhage at our tertiary referral center. These findings should be interpreted within the context of this institutional setting and do not exclude the possibility that point-of-care testing may provide clinical benefit in other patient populations or healthcare settings. Further studies are needed to identify the clinical settings in which point-of-care testing-guided transfusion strategies are most effective.
OBJECTIVE:The Psychological Expectation Scale for Patients with Middle- and Late-Stage Cervical Cancer (PES-PMLSCC) was developed to assess the psychological expectations of patients with middle and late cervical cancer, and its reliability, validity, and acceptability were tested. METHOD:Employing classical test theory methodology, a cohort of 148 cervical cancer patients classified as FIGO Stage III or IV (or equivalent TNM staging) was enrolled in this study. The PES-PMLSCC scale was developed. The initial iteration of the PES-PMLSCC was refined through item analysis. To assess the structural validity of the final scale, exploratory factor analysis (EFA) was conducted, followed by preliminary internal validation using confirmatory factor analysis (CFA) and structural equation modeling (SEM). The criterion-related validity (CRV) of the final PES-PMLSCC version was evaluated by calculating the Pearson correlation coefficient between the PES-PMLSCC and the QLQ-C30. RESULTS:The PES-PMLSCC scale comprises 14 items distributed across four subscales: physiological needs (three items), safety needs (four items), social needs (two items), and self-actualization (five items). Preliminary evidence of reliability, as indicated by a Cronbach's alpha of 0.819, a Spearman-Brown coefficient of 0.912, and a test-retest reliability coefficient of 0.928. The preliminary internal validation of the validity showed that χ2/df = 1.39, GFI = 0.93, CFI = 0.98, NFI = 0.93, IFI = 0.98, TLI = 0.97, RMSEA = 0.05, and the I-CVIs exceeded 0.80. CONCLUSIONS:The findings indicate that the PES-PMLSCC is applicable for assessing the level of psychological expectations among patients with middle- and late-stage cervical cancer in China, particularly in the southwestern region.
BACKGROUND:Wired electronic fetal monitoring (EFM) restricts maternal mobility during labor and may negatively affect pain coping, comfort, birth satisfaction. Although both wired and wireless systems are available, wired EFM remains the standard method in many countries, including Türkiye. This randomized controlled trial evaluated the effects of wireless EFM on maternal comfort, labor pain, birth satisfaction. MATERIALS AND METHODS:The final sample comprised 88 women, with 44 participants in the experimental group and 44 in the control group. Data were collected using the personal information form, childbirth comfort questionnaire (CCQ), visual analog scale (VAS), and birth satisfaction scale-revised (BSS-R). Women in the experimental group were monitored using wireless EFM, whereas those in the control group received conventional wired EFM. The VAS and CCQ were administered during the active phase of labor (8-10 cm cervical dilatation), and the BSS-R was completed 1 h postpartum. RESULTS:Labor duration was shorter, reactive EFM findings were more frequent in the experimental group. Mean CCQ and BSS-R scores were higher, whereas mean VAS scores were lower in the experimental group. Significant between-group differences were observed for VAS and BSS-R scores, whereas the difference in CCQ scores was not statistically significant. CONCLUSION:Women monitored with wireless EFM experienced lower perceived labor pain and higher birth satisfaction than those receiving conventional wired EFM. Wireless EFM was also associated with shorter labor duration and a higher rate of reactive EFM findings. These findings suggest that wireless EFM may improve women's childbirth experience while maintaining effective fetal monitoring.
AIM:This study aimed to clarify the clinical significance of perinatal changes in fibroblast growth factor 21 and their association with postpartum metabolic outcomes in women with gestational diabetes mellitus. METHODS:This single-center retrospective observational study used prospectively collected residual serum samples to investigate longitudinal changes in serum fibroblast growth factor 21 concentrations at approximately 26 (T1) and 36 (T2) weeks of gestation and within 7 days postpartum (T3) in 45 women with gestational diabetes mellitus and 30 controls. Associations between fibroblast growth factor 21 concentrations and postpartum metabolic outcomes were evaluated in the gestational diabetes mellitus group. RESULTS:Serum fibroblast growth factor 21 concentrations increased significantly from T1 to T2 and remained elevated at T3, irrespective of gestational diabetes mellitus status, as assessed using the Friedman test with post hoc comparisons. In women with gestational diabetes mellitus, fibroblast growth factor 21 showed predictive performance for postpartum insulin resistance, as assessed using the homeostasis model assessment of insulin resistance. Receiver operating characteristic analysis showed the highest area under the curve for predicting postpartum insulin resistance at T1 (area under the curve, 0.871; bootstrap 95% confidence interval, 0.732-0.973). Fibroblast growth factor 21 concentrations appeared to decline during the early postpartum period, as indicated by significantly lower T3/T1 ratios in samples from postpartum Days 5-7 compared with those from Days 1-4. CONCLUSIONS:These findings suggest that perinatal fibroblast growth factor 21 dynamics may reflect physiological changes in insulin sensitivity and that fibroblast growth factor 21 concentrations measured during pregnancy may serve as a complementary indicator for postpartum metabolic risk stratification in women with gestational diabetes mellitus. Further validation is needed before clinical application.
AIM:To investigate the determinants of fetal growth abnormalities such as large for gestational age (LGA) and small for gestational age (SGA) in singleton pregnancies complicated by maternal psychiatric disorders, particularly focusing on the impact of psychotropic medication exposure and maternal background factors on infants. METHODS:A retrospective single-center cohort study was conducted involving 400 singleton pregnancies complicated by maternal psychiatric disorders, with deliveries occurring between 2019 and 2023. Data regarding maternal characteristics, psychiatric diagnoses, psychotropic medication use including polypharmacy and metabolically high-risk psychotropic medications, and obstetric outcomes were extracted from medical records. Infants were classified as LGA or SGA according to gestational age-specific birth weight standards. Multivariable logistic regression analyses were performed to identify independent factors associated with LGA and SGA. RESULTS:Of the 400 pregnancies, 40 infants were classified as LGA and 40 as SGA. Psychotropic medication use, including polypharmacy and metabolically high-risk psychotropic medications, was not independently associated with either LGA or SGA. For LGA, only high prepregnancy BMI was identified as an independent risk factor. For SGA, hypertensive disorders of pregnancy, maternal alcohol consumption, and lower prepregnancy BMI were independently associated with increased risk. CONCLUSIONS:In pregnancies complicated by psychiatric disorders, fetal growth abnormalities were primarily associated with maternal background factors. No statistically significant association was identified between psychotropic medication use and LGA or SGA fetuses in our study cohort. These findings highlight the potential importance of preconception care focused on optimizing metabolic health and lifestyle factors to improve fetal growth outcomes.
Uterine arteriovenous fistula (UAVF) associated with adenomyosis during pregnancy is a rare, life-threatening condition. This report describes a 36-year-old woman with adenomyosis who conceived through in vitro fertilization-embryo transfer and experienced recurrent vaginal bleeding in early pregnancy, followed by spontaneous miscarriage at 14 weeks. One month post-miscarriage, she developed a delayed massive hemorrhage. Color Doppler ultrasound revealed mosaic blood flow signals and high-velocity low-resistance spectra (resistance index 0.52) within the myometrium, confirming acquired UAVF. Emergency uterine artery embolization achieved successful hemostasis while preserving bilateral uterine artery trunks. Menstruation resumed 3 months postoperatively. This case raises the hypothesis of a possible association between adenomyosis and pregnancy-related UAVF. In patients with adenomyosis who are pregnant, recurrent early bleeding that is unresponsive to conservative therapy should raise suspicion for underlying vascular abnormalities, and color Doppler ultrasound evaluation may be warranted. Delayed explosive post-miscarriage hemorrhage refractory to uterotonics is characteristic. UAE is the preferred fertility-sparing treatment, with individualized embolization strategies and long-term follow-up essential.
