Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female

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Uterine artery embolization (UAE) has been discovered as a viable therapeutic strategy to treat DUB following an incomplete abortion. The existing information and clinical experience of UAE for this particular indication were thoroughly reviewed. A female’s quality of life may be negatively affected by incomplete abortion, which is defined as residual fetal tissue inside the uterine cavity. This frequently results in heavy and continuous uterine bleeding. Medical procedures and traditional management techniques such as dilatation and curettage (D&C) do not always produce the desired effects or might have inherent dangers. UAE, a less invasive technique first developed for treating uterine fibroids, has shown promise as a substitute solution for DUB caused by an incomplete abortion." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-473", "name": "Case Report: Uterine artery embolization after dysfunctional uterine..." } } ] } Home Browse Case Report: Uterine artery embolization after dysfunctional uterine... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Jha S, Inamdar S and Dhobale A. Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :473 ( https://doi.org/10.12688/f1000research.142066.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] Sagar Jha https://orcid.org/0009-0007-3368-3206 1,2 , Saunitra Inamdar https://orcid.org/0000-0002-7054-3006 3 , Anupama Dhobale 4 Sagar Jha https://orcid.org/0009-0007-3368-3206 1,2 , Saunitra Inamdar https://orcid.org/0000-0002-7054-3006 3 , Anupama Dhobale 4 PUBLISHED 10 May 2024 Author details Author details 1 Resident obstetrics and gynecology, Datta Meghe Institue for Higher Education and Research, nagpur, maharashtra, 441110, India 2 Resident obstetrics and gynecology, Datta Meghe Medical College, Nagour, Maharashtra, 441110, India 3 HOD obstetrics and gynecology, Datta Meghe Institute For Higher Education and Research, Nagpur, maharashtra, 441110, India 4 assistant professor Obstetrics and gynecology, Datta Meghe Institute For HIgher education and Research, Nagpur, maharashtra, 441110, India Sagar Jha Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Saunitra Inamdar Roles: Data Curation, Formal Analysis, Funding Acquisition, Investigation, Supervision, Validation Anupama Dhobale Roles: Data Curation, Formal Analysis, Methodology, Project Administration, Resources, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Dysfunctional uterine bleeding (DUB), a serious clinical challenge caused by incomplete abortion in female, calls for efficient and minimally invasive therapies to treat symptoms and protect reproductive health. Uterine artery embolization (UAE) has been discovered as a viable therapeutic strategy to treat DUB following an incomplete abortion. The existing information and clinical experience of UAE for this particular indication were thoroughly reviewed. A female’s quality of life may be negatively affected by incomplete abortion, which is defined as residual fetal tissue inside the uterine cavity. This frequently results in heavy and continuous uterine bleeding. Medical procedures and traditional management techniques such as dilatation and curettage (D&C) do not always produce the desired effects or might have inherent dangers. UAE, a less invasive technique first developed for treating uterine fibroids, has shown promise as a substitute solution for DUB caused by an incomplete abortion. READ ALL READ LESS Keywords Abortion, Embolization, Bleeding, Dysfunctional uterine bleeding, Uterine artery. Corresponding Author(s) Sagar Jha ( [email protected] ) Close Corresponding author: Sagar Jha Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Jha S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Jha S, Inamdar S and Dhobale A. Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :473 ( https://doi.org/10.12688/f1000research.142066.1 ) First published: 10 May 2024, 13 :473 ( https://doi.org/10.12688/f1000research.142066.1 ) Latest published: 10 May 2024, 13 :473 ( https://doi.org/10.12688/f1000research.142066.1 ) Introduction The most typical application of uterine artery embolization in females is a minimally invasive technique that relieves vaginal bleeding caused by uterine fibroids (non-cancerous tumors inside the uterus). 1 Uterine artery embolization (UAE) can treat excessive bleeding in emergency cases caused by trauma, malignant (cancerous) gynecological tumors, or postpartum hemorrhage, in addition to fibroids. With over 25 years of supporting data, uterine artery embolization has been demonstrated to be a safe and efficient treatment for symptomatic uterine fibroid. 2 UAE is a well-known form of treatment, but there are a few misconceptions that may make it less accessible to some patients. However, there are difficulties that can make it more difficult for interventional radiologists to provide the best care and treatment for specific patients. This paper will overcome these misconceptions and difficulties, offering opportunities for future development and innovation to help interventional radiologists better serve this patient population. 3 Abortion is common practice. Although inaccurate, data on abortion rates can be used to examine the trends. Worldwide, the rate was 35 abortions per 1000 women aged 15–44 years in 2010–2014, which is almost five points less than that of 40 abortions for years between 1990 and 1994. 4 Although there are different abortion regulations around the world, they are typically stricter in developing nations. However, limiting the regulations frequently results in risky procedures. Despite high rates of death and morbidity, they do not always stop women from getting abortions. Accessibility necessitates a legal framework for abortion, yet numerous regulations are not supported by evidence of restricted accessibility and delayed access. 5 Abortion is a frequent practice, and data on abortion rates could be utilized to look at patterns despite being erroneous. From 2010 to 2014, there were 35 abortions per 1000 women worldwide (aged 15–44 years), which is a five-point decrease. For the sake of public health, abortion should be accessible, and any legal framework should also be as tolerant as feasible to promote access. Strategies for harm reduction are necessary to lower abortion-related mortality and morbidity in the absence of legal access. 6 Both medical and surgical methods of abortion are effective and safe (in the first trimester, via manual or electric vacuum aspiration). Cervical priming made surgery easier, and the chances of unsuccessful abortion were lower. Septic abortions are a common and typically preventable cause of maternal deaths that almost invariably follow botched abortions. All women should be given access to a type of contraception as soon as feasible, even though normal post-abortion follow-up is not required. Together with improved education and other efforts, this may minimize unintended pregnancies. 7 Case presentation This case study focuses on an Indian woman from the Vidarbha region in Maharashtra who chose Shalini Tai Meghe Hospital, Nagpur, for treatment. A 27 year old woman was diagnosed as having dysfunctional uterine bleeding. She was counselled about all the procedures, merits, and demerits, and informed consent was obtained. Medical history A 27 year old women, married for 7 years of G4P2L2A1, presented with a complaint of bleeding per vaginum for 6 h and pain in the abdomen for 8 h. She had a history of two previous LSCS cases with a last childbirth of 1.5 years back, she also had a history of spontaneous abortion for a three-and-a-half-month gestational age for which dilatation and curettage were done. 6 Her last menstrual cycle was, 22/08/2022. Her expected delivery date was 29/05/23, and her gestation period was 10 weeks 5days. The patient had no recent history of heavy weight lifting or coitus and no history of diabetes mellitus, bronchial asthma, or epilepsy. The patient had no history of major surgical illness or blood transfusion. Clinical findings On general examination pulse was 76 bpm, respiratory rate of 18 per/min BP: 100/72 mmHg. Patient was a febrile on touch, on systemic examination RS-air entry bilateral equal on CVS-S1 S2 heard, no murmur, CNS: conscious and oriented, per abdominal examination: soft non-tender, per vaginal examination: OS admits tip of finger, bleeding++, patient was immediately advice for USG abdomen +pelvis and blood investigation. USG done on 05/11/2022, suggestive of retained products of conception. An immediate decision to check for curettage was made. All blood tests were performed and were within normal limits. Procedure was completed and was uneventful, patient was admitted in ward for observation. The patient continued to bleed, and passage of blood clots was observed in the valvar pads even after successful check curettage. A repeat USG was suggested to check for any RPOC in the uterus. USG was performed on 7/11/22, suggestive of blood clots in the uterus, and the patient was counselled. Regarding the current condition and was given the option of either hysterectomy or uterine artery embolization, considering the patient’s age. The decision to perform uterine artery embolization was made, the patient was referred for uterine artery embolization, as shown in Figure 1 . Figure 1. Uterine blood supply before uterine artery embolization. Treatment plan During the procedure, there was a nidus of multiple tortuous vessels with feeders from the uterine artery, and super selective cannulation was performed with a progreat microcatheter and embolization was performed using PA particles of size 5 mm, as shown in Figure 2 . Post-embolization reduced the contrast blush arising from the uterine artery, and the procedure was uneventful, as shown in Figure 3 . Figure 2. Embolization with polyvinyl alcohol particle. Figure 3. Uterine artery blood supply after uterine artery embolization. Regarding postoperative medications, patient was advised for the injection. Tranexa 8 hourly, injection Cefotaxim 12 hourly, Injection Pantoprazole 24 hourly, Injection Diclofenac 12 hourly, Tablet methergin 0.25 mg 8 hourly. The patient complained of pain after the procedure for 2 days, for which she was administered an injection. Tramadol, which relieved the patient’s pain tremendously. Discussion Pados G. et al. reported that acute dysfunctional uterine bleeding (DUB) in female is treated medically with hormones, NSAIDs, and antifibrinolytic drugs. Hormonal therapy is regarded as the standard medical treatment for acute DUB. Conjugated equine estrogen administered intravenously, COCs, and oral and intramuscular progestins are among the available treatments. A randomized double-blind study including 34 women demonstrated the effectiveness of intravenous conjugated equine estrogen in DUB therapy. According to the study, uterine hemorrhage decreased by 72% in comparison to 38% in the placebo group 8 h after intravenous premarin was administered. 8 According to a theory, the endometrium heals itself as a result of the induced growth caused by growing oestradiol levels during the primary follicular phase of a typical menstrual cycles. Estrogen also has an impact on the endometrium by reducing capillary permeability, increasing fibrinogen levels, clotting factors, and platelet aggregation, which in turn encourages coagulation and decreases capillary permeability. COCs and oral progestins are among the additional types of hormonal therapies. Progestogens unaccompanied or in combination with estrogen have the same therapeutic effect when used to treat anovulatory DUB, according to a recent Cochrane study. 9 NSAIDs and antifibrinolytics can be used in ovulatory DUB patients on days when there is significant uterine bleeding. In comparison to single-agent therapy, the use of these drugs in combination with other agents can result in a larger decrease in uterine bleeding. It has been discovered that antifibrinolytics reduce uterine hemorrhage by 40–50% from baseline in comparison with placebo. They have also been reported to be higher than NSAIDs, with a 25–50% decrease in menstrual blood loss from the baseline. 10 Surgery is only used for hysterectomy, UAE, and endometrial ablation in patients with acute DUB. Currently, only women with fibroids have been found to benefit from the use of UAE for menorrhagia. After five years of follow-up, the EMMY trial revealed that 70% of the patients who were randomly assigned to the UAE group did not require hysterectomy. To date, only one instance illustrating the use of UAE in the treatment of acute DUB has been documented in the literature. For example, a 12 years girl with first-onset menorrhagia, which was life threatening, was treated with UAE after traditional medical or gynecological procedures had failed to work. 11 UAE has been demonstrated to be effective in treating postpartum hemorrhage, with reported success rates of >90%, in addition to its involvement in menorrhagia. In one of the registers, it was discovered that 2% of the patients experienced uterine infection after UAE. One patient in the case series of these 21 individuals experienced multiple organ failure and septic shock leading to death following UAE, according to a systematic evaluation of 36 articles. Additional issues include intestinal perforation, groyne hemorrhage or pseudoaneurysm, femoral artery blockage, and arterial dissection or perforation. 12 However, only 4.8% of the total number of women enlisted belonged to the category of women with three or more previous sections. After using impedance-controlled endometrial ablation in a patient who had previously undergone three transverse caesarean sections, the patient developed a vesicouterine fistula, raising concerns about the safety of endometrial ablation. Endometrial ablation was not seen to be the best course of treatment for our patient because there is conflicting evidence on its safety in women who had three previous caesarean sections and because our hospital offers only microwave endometrial ablation, which is performed in the dark. 13 In this case, UAE was attempted because the patient did not respond to medical treatment of DUB and expressed no interest in undergoing hysterectomy. Both times after the UAE, her monthly bleeding was controlled. Angiographic evidence of a convoluted right uterine artery indicates an increase in the caliber and flow of the right uterine artery. However, research on monkeys has revealed that convoluted uterine arteries are the only anatomical variance. In conclusion, we hypothesized that UAE might have a role in treating acute DUB in women whose fertility must be preserved. However, further research is needed to determine the efficacy of UAE in the treatment of acute DUB. 14 Conclusion UAE is an effective and safe treatment option for DUB associated with incomplete abortion. The procedure can provide quick and lasting relief of symptoms with a low risk of complications. UAE should be considered an alternative to a more invasive surgical option for the administration of DUB related to incomplete abortion. However, patient selection, careful evaluation of the jeopardies, and benefits of the procedure are important factors to consider. Consent The patient provided written informed consent for the publication of this manuscript. Data availability No data are associated with this article. References 1. Wong GC, Muir SJ, Lai AP: Uterine artery embolization: A minimally invasive technique for the treatment of uterine fibroids. J. Women Health Gend.-Based Med. 2000 May; 9 (4): 357–362. Publisher Full Text 2. Young M, Coffey W, Mikhail LN: Uterine Fibroid Embolization. StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 [cited September 5, 2023]. Reference Source 3. Women’s Issues in Interventional Radiology: Uterine Artery Embolization for Treatment of Symptomatic Fibroids - PMC.[cited September 5, 2023]. Reference Source 4. Singh S, Shekhar C, Acharya R, et al. : Incidence of abortion and unintended pregnancy in India in 2015. Lancet Glob. Health. 2018 Jan 1; 6 (1): e111–e120. PubMed Abstract | Publisher Full Text | Free Full Text 5. Berer M: Abortion Law and Policy Around the World. Health Hum. Rights. 2017 Jun; 19 (1): 13–27. PubMed Abstract 6. Induced abortion|Human Reproduction|Oxford Academic.[cited September 5, 2023]. Reference Source 7. Medical termination for pregnancy in early first trimester (≤ 63 days) using a combination of mifepristone and misoprostol or misoprostol alone: a systematic review. BMC Women’s Health. [cited September 5, 2023]. Publisher Full Text 8. Pados G, Athanatos D, Stamatopoulos P, et al. : Treatment options for dysfunctional uterine bleeding: evaluation of clinical results. Gynecol. Surg. 2011 Nov; 8 (4): 385–393. Publisher Full Text 9. Bradley LD, Gueye NA: Medical management of abnormal uterine bleeding in reproductive-aged women. Am. J. Obstet. Gynecol. 2016 Jan 1; 214 (1): 31–44. PubMed Abstract | Publisher Full Text 10. Strickler RC: Dysfunctional uterine bleeding in ovulatory women. Postgrad. Med. 1985 Jan; 77 (1): 235–246. 240–243, 246. Publisher Full Text 11. Bhattacharya S, Middleton LJ, Tsourapas A, et al. : Hysterectomy, endometrial ablation and Mirena for heavy menstrual bleeding: a systematic review and individual patient data meta-analysis. Hysterectomy, Endometrial Ablation and Mirena ® for Heavy Menstrual Bleeding: A Systematic Review of Clinical Effectiveness and Cost-Effectiveness Analysis. NIHR Journals Library; 2011 [cited 2023 Sep 5]. Reference Source 12. Successful repeated uterine artery embolization in postpartum hemorrhage with disseminated intravascular coagulation: a case report and literature review. BMC Pregnancy and Childbirth. [cited 2023 Sep 5]. Publisher Full Text 13. Endometrial ablation: postoperative complications. Am. J. Obstet. Gynecol. [cited 2023 Sep 5]. Reference Source 14. Mailli L, Patel S, Das R, et al. : Uterine artery embolisation: fertility, adenomyosis and size – what is the evidence? CVIR Endovasc. 2023 Feb 27; 6 (1): 8. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 10 May 2024 ADD YOUR COMMENT Comment Author details Author details 1 Resident obstetrics and gynecology, Datta Meghe Institue for Higher Education and Research, nagpur, maharashtra, 441110, India 2 Resident obstetrics and gynecology, Datta Meghe Medical College, Nagour, Maharashtra, 441110, India 3 HOD obstetrics and gynecology, Datta Meghe Institute For Higher Education and Research, Nagpur, maharashtra, 441110, India 4 assistant professor Obstetrics and gynecology, Datta Meghe Institute For HIgher education and Research, Nagpur, maharashtra, 441110, India Sagar Jha Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Saunitra Inamdar Roles: Data Curation, Formal Analysis, Funding Acquisition, Investigation, Supervision, Validation Anupama Dhobale Roles: Data Curation, Formal Analysis, Methodology, Project Administration, Resources, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 10 May 2024, 13:473 https://doi.org/10.12688/f1000research.142066.1 Copyright © 2024 Jha S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Jha S, Inamdar S and Dhobale A. Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :473 ( https://doi.org/10.12688/f1000research.142066.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 10 May 2024 Views 0 Cite How to cite this report: Liao AH. Reviewer Report For: Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :473 ( https://doi.org/10.5256/f1000research.155563.r325438 ) The direct URL for this report is: https://f1000research.com/articles/13-473/v1#referee-response-325438 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Oct 2024 Ai-Hua Liao , Huazhong University of Science and Technology, Wuhan, Hubei, China Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.155563.r325438 The manuscript by Dr. Jha et al. presented a case report on the successful treatment of uterine artery embolization (UAE) after dysfunctional uterine bleeding (DUB) due to in complete abortion in 27-years old woman. However, it still needs more cases ... Continue reading READ ALL The manuscript by Dr. Jha et al. presented a case report on the successful treatment of uterine artery embolization (UAE) after dysfunctional uterine bleeding (DUB) due to in complete abortion in 27-years old woman. However, it still needs more cases to confirm the efficacy, and the following concerns should also be addressed. 1. The background on this topic is insufficient. Although the authors mentioned that there were a few misconceptions on UAE, they did not clearly mention what they are, specially, in view of abortion. In the second paragraph of the introduction, the authors just presented the status of abortion rates worldwide. They did not point out what the key or main issues regarding abortion. It is suggested that the authors should clearly point out and focus on what the main issues exist regarding their topic of this manuscript. Specially, whether this case report is the first one? If not, the authors should summarize the current status on the use of UAE in the DUB related incomplete abortion. Moreover, the authors should describe what it is new or different from others. Hence, all the above-mentioned points should be presented in the part of the introduction. 2. Discussion The authors only reported one case with successful outcome after the treatment of UAE. However, whether it can be wildly used by others remains limited. The authors should follow up the long-term status of fertility and menstruation. Also, it needs more cases to approve the efficacy. Moreover, they should discuss how the other practitioners use their results, and what the limitation of this study is. Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Gynecology, Reproductive medicine. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Liao AH. Reviewer Report For: Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :473 ( https://doi.org/10.5256/f1000research.155563.r325438 ) The direct URL for this report is: https://f1000research.com/articles/13-473/v1#referee-response-325438 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 10 May 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 10 May 24 read Ai-Hua Liao , Huazhong University of Science and Technology, Wuhan, China Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Liao A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Oct 2024 | for Version 1 Ai-Hua Liao , Huazhong University of Science and Technology, Wuhan, Hubei, China 0 Views copyright © 2024 Liao A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript by Dr. Jha et al. presented a case report on the successful treatment of uterine artery embolization (UAE) after dysfunctional uterine bleeding (DUB) due to in complete abortion in 27-years old woman. However, it still needs more cases to confirm the efficacy, and the following concerns should also be addressed. 1. The background on this topic is insufficient. Although the authors mentioned that there were a few misconceptions on UAE, they did not clearly mention what they are, specially, in view of abortion. In the second paragraph of the introduction, the authors just presented the status of abortion rates worldwide. They did not point out what the key or main issues regarding abortion. It is suggested that the authors should clearly point out and focus on what the main issues exist regarding their topic of this manuscript. Specially, whether this case report is the first one? If not, the authors should summarize the current status on the use of UAE in the DUB related incomplete abortion. Moreover, the authors should describe what it is new or different from others. Hence, all the above-mentioned points should be presented in the part of the introduction. 2. Discussion The authors only reported one case with successful outcome after the treatment of UAE. However, whether it can be wildly used by others remains limited. The authors should follow up the long-term status of fertility and menstruation. Also, it needs more cases to approve the efficacy. Moreover, they should discuss how the other practitioners use their results, and what the limitation of this study is. Is the background of the case’s history and progression described in sufficient detail? No Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests No competing interests were disclosed. Reviewer Expertise Gynecology, Reproductive medicine. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Liao AH. Peer Review Report For: Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :473 ( https://doi.org/10.5256/f1000research.155563.r325438) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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last seen: 2026-05-20T01:45:00.602351+00:00