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Kitahara Y, Hiraike O, Ishikawa H, Kugu K, Takai Y, Yoshino O, Ono M, Maekawa R, Ota I, Iwase A. Diagnosis of abnormal uterine bleeding based on the FIGO classification: A systematic review and expert opinions. J Obstet Gynaecol Res 2024. [PMID: 39234899 DOI: 10.1111/jog.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 08/23/2024] [Indexed: 09/06/2024]
Abstract
AIM To present evidence- and consensus-based recommendations for the diagnosis abnormal uterine bleeding. METHODS A literature search for the diagnosis of abnormal uterine bleeding was systematically conducted in PubMed from its inception to May 2024 to identify meta-analyses, reviews, randomized controlled trials, and clinical trials, followed by an additional systematic search using keywords. Based on this evidence, an expert panel developed background, clinical, and future research questions. RESULTS Based on a systematic search and the collected evidence, we developed five background questions, three clinical questions, and one future research question, with recommendations and/or statements. Evidence and recommendations are provided for clinical questions. Additionally, we developed a flowchart for diagnosis showing the steps of the examinations to be performed. CONCLUSION The flowchart and nine recommendations/statements specify an efficient diagnostic procedure to differentiate abnormal causative diseases of uterine bleeding optimized for actual Japanese situations.
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Affiliation(s)
- Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, the University of Tokyo, Bunkyo-ku, Japan
| | - Hiroshi Ishikawa
- Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Koji Kugu
- Department of Pharmaceutical Sciences (Narita Campus), International University of Health and Welfare, Narita, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi Hospital, Chuo, Japan
| | - Masanori Ono
- Department of Obstetrics and Gynecology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Ryo Maekawa
- Department of Obstetrics and Gynecology, Yamaguchi University Hospital, Ube, Japan
| | - Ikuko Ota
- Department of Gynecology, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Clinical Curative Effects and Influencing Factors of Uterine Artery Chemoembolization Combined with Uterine Curettage Treating with Cesarean Scar Pregnancy Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7785573. [PMID: 36204121 PMCID: PMC9532077 DOI: 10.1155/2022/7785573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the clinical curative effects of uterine arterial chemoembolization (UACE) combined with uterine curettage treating with cesarean scar pregnancy (CSP) patients, and analyze the influencing factors of postoperative efficacy. Methods A total of 86 patients with CSP from January 2019 to December 2021 in the Gynecology ward of our hospital were selected and divided into the control group (n = 43) and the observation group (n = 43) according to the random number method. The control group was treated with an injection of methotrexate (MTX) combined with uterine curettage, and the observation group was treated with UACE combined with uterine curettage. Two months after the operation, the therapeutic effect, cesarean scar mass, and β-human chorionic gonadotropin (β-HCG) level were observed and compared between the two groups. The general conditions of patients in two groups were recorded, and the influencing factors of surgical efficacy in patients were analyzed using univariate analysis and a multivariate logistic regression model. Results After treatment, the total effective rate of the observation group was significantly higher than that of the control group (P < 0.05). The volume of intraoperative blood loss, hospitalization period, menstrual recovery time, mass disappearance time, and β-HCG recovery time of the observation group were lower than those of the control group (P < 0.05). Single factor analysis showed that the number of cesarean sections, gestational age, the largest diameter of the gestational sac, the thinnest muscular layer, and the type of CSP can all affect postoperative efficacy (P < 0.05). Multivariate logistic analysis showed that the gestational age, a maximum diameter of a gestational sac, the thinnest muscular layer, and the type of CSP were independent factors influencing the postoperative efficacy of the patients (P < 0.05). Conclusion UACE combined with uterine curettage for CSP can significantly improve the curative effect, reduce intraoperative bleeding, and improve the recovery time of postoperative-related symptoms. The gestational age of the patient, the maximum diameter of the gestational sac, the thinnest muscular layer, and the type of CSP can independently affect the therapeutic effect of CSP patients. Fully understanding the high-risk factors that affect the efficacy of treatment of CSP, timely preventive measures, and targeted care can effectively improve the prognosis and reduce the risk of CSP.
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Keller CA, Antil N, Jeffrey RB, Kamaya A. Color Doppler Imaging of Vascular Abnormalities of the Uterus. Ultrasound Q 2022; 38:72-82. [PMID: 35239631 DOI: 10.1097/ruq.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Many uterine abnormalities present clinically with bleeding encompassing a broad spectrum of patients from postmenopausal spotting to life-threatening hemorrhage. Color and spectral Doppler imaging of the pelvis is often the first crucial investigation used to quickly establish the correct etiology of the uterine bleeding and guide clinical decision making and patient management.
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Affiliation(s)
- Cody A Keller
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
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Parisi S, Garofalo A, Alemanno MG, Chiado Fiorio Tin M, Petruzzelli P, Viora E. Arteriovenous uterine malformation developed from an interstitial pregnancy on residual tubal stump: A critical managment in a fertile woman. J Obstet Gynaecol Res 2019; 46:176-180. [PMID: 31608528 DOI: 10.1111/jog.14144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
Uterine arteriovenous malformations are rare conditions with diverse clinical presentation that range from asymptomatic patients to different degrees of menorrhagia, commonly associated with previous pregnancy or uterine trauma. This case report describes a 36-year-old woman who presented with ultrasound diagnosis of interstitial pregnancy on residual right tube stump 4 months after a laparoscopic salpingectomy for extrauterine pregnancy. She started treatment with methotrexate; afterwards serum human chorionic gonadotropin levels and ultrasound follow-ups were scheduled. While serum human chorionic gonadotropin levels were progressively reducing, transvaginal ultrasound follow-ups showed a persistent anechoic mass on right rube stump, with increased peripheral high flow vascularity: highly suspicious for a uterine arteriovenous malformation. A laparoscopy was performed with a tumorectomy of the mass. The histopathological exam of the specimen confirmed uterine arteriovenous malformation. Patient successfully became pregnant 2 years later, with an eventless pregnancy and a vaginal delivery without complications.
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Affiliation(s)
- Silvia Parisi
- Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Anna Garofalo
- Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Maria Grazia Alemanno
- Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Michela Chiado Fiorio Tin
- Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Paolo Petruzzelli
- Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Elsa Viora
- Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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Taneja A, Chopra I, Kaur H, Naik SS, Aggarwal R, Sachdeva E, Kaur P. Successful management of abnormal uterine bleeding from uterine arteriovenous malformations with progesterone in postabortal patients. J Obstet Gynaecol Res 2019; 45:1114-1117. [DOI: 10.1111/jog.13939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ashima Taneja
- Department of Obstetrics and GynaecologyDayanand Medical College and Hospital Ludhiana India
| | - Isha Chopra
- Department of Obstetrics and GynaecologyDayanand Medical College and Hospital Ludhiana India
| | - Harmeet Kaur
- Department of Obstetrics and GynaecologyDayanand Medical College and Hospital Ludhiana India
| | - Sushree S. Naik
- Department of Obstetrics and GynaecologyAll India Institute of Medical Sciences Bhubaneswar India
| | - Reetika Aggarwal
- Department of Obstetrics and GynaecologyDayanand Medical College and Hospital Ludhiana India
| | - Eshani Sachdeva
- Department of Obstetrics and GynaecologyDayanand Medical College and Hospital Ludhiana India
| | - Poonampreet Kaur
- Department of Obstetrics and GynaecologyDayanand Medical College and Hospital Ludhiana India
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Ghizzoni V, Gabbrielli S, Mannini L, Sorbi F, Turrini I, Fantappiè G, Pavone D, Fambrini M, Noci I. Spontaneous Resolution of an Acquired Uterine Arteriovenous Malformation in an Elderly Primigravida. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1140-1145. [PMID: 30258044 PMCID: PMC6180955 DOI: 10.12659/ajcr.909635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 06/12/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Uterine arteriovenous malformation (AVM) is an uncommon lesion characterized by an abnormal connection between arterial and venous circulation that can be congenital or acquired. Acquired uterine AVMs are generally traumatic and follow delivery, abortion, curettage, or uterine surgery. CASE REPORT A 45-year-old female who was gravida 1 para 0 presented to our hospital with severe vaginal bleeding. Two weeks before, the patient underwent therapeutic abortion. At admission, a transvaginal ultrasound showed an unclear intrauterine lesion that spread out to the myometrium. Color Doppler evaluation demonstrated an elevated color score. Beta human chorionic gonadotropin (beta-hCG) levels were measured at admission and daily repeated, with a progressive decrease of values up to a negative level. A pelvic magnetic resonance imaging described an area of tubular and tortuous structures involving the myometrium. A computed tomography angiography confirmed the presence of a lesion infiltrating the endometrium and myometrium containing arteriovenous structures with a highly enhanced effect. Despite these findings, the patient was clinically stable. A diagnosis of uterine AVM was made and, after accurate counselling with the patient, she was discharged and underwent "watch and wait" management. After 35 days, the patient had a follow-up ultrasound that showed a complete resolution of the uterine lesion. CONCLUSIONS AVM should be considered in the presence of heavy and sudden vaginal bleeding in a patient with risk factors for acquired AVM. A color Doppler ultrasound scan should be performed as the first approach and an expectant management should be taken into account especially with a patient of childbearing age and hemodynamic instability.
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Affiliation(s)
- Viola Ghizzoni
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | | | - Luca Mannini
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Flavia Sorbi
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Irene Turrini
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Giulia Fantappiè
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Dora Pavone
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
| | - Ivo Noci
- Department of Biomedical Clinical and Experimental Sciences, University of Florence, Florence, Italy
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Uterine Arteriovenous Malformation After Molar Pregnancy: A Case Report and Review of Literature. WOMEN’S HEALTH BULLETIN 2017. [DOI: 10.5812/whb.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tenkumo C, Kanenishi K, AboEllail MAM, Yamamoto K, Ishibashi M, Mori N, Tanaka H, Hata T. HDlive Flow silhouette mode for the diagnosis of uterine enhanced myometrial vascularity/arteriovenous malformations. J Med Ultrason (2001) 2017; 45:349-352. [PMID: 28840423 DOI: 10.1007/s10396-017-0823-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Abstract
We present our initial experience of using the HDlive Flow silhouette mode to construct images of two cases of uterine enhanced myometrial vascularity/arteriovenous malformations (EMV/AVMs). In the first case, the HDlive Flow silhouette mode clearly depicted a fused vascular tumor with irregular contour in the posterior myometrium. In the second case, a large hypervascular mass occupying the entire fundal lesion of the uterus was clearly identified using the HDlive Flow silhouette mode. Moreover, spatial relationships among the hypervascular mass, intrauterine blood collection, and dilated, spiral-shaped right uterine artery enabled the clear localization of the mass. The HDlive Flow silhouette mode provides a novel, unique sonographic image of uterine EMV/AVMs, and might facilitate their diagnosis and localization in the myometrium.
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Affiliation(s)
- Chiaki Tenkumo
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Mohamed Ahmed Mostafa AboEllail
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenta Yamamoto
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Megumi Ishibashi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Nobuhiro Mori
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Hirokazu Tanaka
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan.
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Plowman RS, Javidan-Nejad C, Raptis CA, Katz DS, Mellnick VM, Bhalla S, Cornejo P, Menias CO. Imaging of Pregnancy-related Vascular Complications. Radiographics 2017; 37:1270-1289. [DOI: 10.1148/rg.2017160128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- R. Scooter Plowman
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Cylen Javidan-Nejad
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Constantine A. Raptis
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Douglas S. Katz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Vincent M. Mellnick
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Patricia Cornejo
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Christine O. Menias
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
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Timor-Tritsch IE, Haynes MC, Monteagudo A, Khatib N, Kovács S. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations. Am J Obstet Gynecol 2016; 214:731.e1-731.e10. [PMID: 26873276 DOI: 10.1016/j.ajog.2015.12.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/12/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Arteriovenous malformation is a short circuit between an organ's arterial and venous circulation. Arteriovenous malformations are classified as congenital and acquired. In the uterus, they may appear after curettage, cesarean delivery, and myomectomy among others. Their clinical feature is usually vaginal bleeding, which may be severe, if curettage is performed in unrecognized cases. Sonographically on 2-dimensional grayscale ultrasound scanning, the pathologic evidence appears as irregular, anechoic, tortuous, tubular structures that show evidence of increased vascularity when color Doppler is applied. Most of the time they resolve spontaneously; however, if left untreated, they may require involved treatments such as uterine artery embolization or hysterectomy. In the past, uterine artery angiography was the gold standard for the diagnosis; however, ultrasound scanning has diagnosed successfully and helped in the clinical management. Recently, arteriovenous malformations have been referred to as enhanced myometrial vascularities. OBJECTIVES The purpose of this study was to evaluate the role of transvaginal ultrasound scanning in the diagnosis and treatment of acquired enhanced myometrial vascularity/arteriovenous malformations to outline the natural history of conservatively followed vs treated lesions. METHODS This was a retrospective study to assess the presentation, treatment, and clinical pictures of patients with uterine Enhanced myometrial vascularity/arteriovenous malformations that were diagnosed with transvaginal ultrasound scanning. We reviewed both (1) ultrasound data (images, measured dimensions, and Doppler blood flow that were defined by its peak systolic velocity and (2) clinical data (age, reproductive status, clinical presentation, inciting event or procedure, surgical history, clinical course, time intervals that included detection to resolution or detection to treatment, and treatment rendered). The diagnostic criteria were "subjective" with a rich vascular network in the myometrium with the use of color Doppler images and "objective" with a high peak systolic velocity of ≥20 cm/sec in the vascular web. Statistical analysis was performed and coded with statistical software where necessary. RESULTS Twenty-seven patients met the diagnostic criteria of uterine enhanced myometrial vascularity/arteriovenous malformation. Mean age was 31.8 years (range, 18-42 years). Clinical diagnoses of the patients included 10 incomplete abortions, 6 missed abortions, 5 spontaneous complete abortions, 5 cesarean scar pregnancies, and 1 molar pregnancy. Eighty-nine percent of patients had bleeding (n = 24/27), although 1 patient was febrile, and 2 patients were asymptomatic. Recent surgical procedures were performed in 55.5% patients (15/27) that included curettage (n = 10), cesarean deliveries (n = 5), or both (n = 1); 4 patients had a remote history of uterine surgery that included myomectomy. Treatment was varied and included expectant treatment alone in 48% of the patients with serial ultrasound scans and serum human chorionic gonadotropin until resolution (n = 13/27 patients), uterine artery embolization (29.6%; 8/27 patients), methotrexate administration (22.2%; 6/27 patients), hysterectomy (7.4%; 2/27 patients), and curettage (3.7%; 1/27 patients). Three patients required a blood transfusion. Of the 9 patients whose condition required embolization, the conditions of 7 patients resolved after the procedure although 1 patient's condition required operative hysteroscopy and 1 patient's condition required hysterectomy for intractable bleeding. Average peak systolic velocity after embolization in the 9 patients was 85.2 cm/sec (range, 35-170 cm/sec); the average peak systolic velocity of the 16 patients with spontaneous resolution was 58.5 cm/sec (range, 23-90 cm/sec). CONCLUSIONS Acquired enhanced myometrial vascularity/arteriovenous malformations occurred after unsuccessful pregnancies or treatment procedures that included uterine curettage, cesarean delivery, or cesarean scar pregnancy. Triage of patients for expectant treatment vs intervention with uterine artery embolization based on their clinical status, which was supplemented by objective measurements of blood velocity measurement in the arteriovenous malformation, appears to be a good predictor of outcome. Ultrasound evaluation of patients with early pregnancy failure and persistent bleeding should be considered for evaluation of a possible enhanced myometrial vascularity/arteriovenous malformation.
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Yoon DJ, Jones M, Taani JA, Buhimschi C, Dowell JD. A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology, Diagnosis, and Transcatheter Treatment. AJP Rep 2016; 6:e6-e14. [PMID: 26929872 PMCID: PMC4737639 DOI: 10.1055/s-0035-1563721] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/15/2015] [Indexed: 12/11/2022] Open
Abstract
Objective An acquired uterine arteriovenous malformation (AVM) is a rare cause of vaginal bleeding and, although hysterectomy is the definitive therapy, transcatheter embolization (TCE) provides an alternative treatment option. This systematic review presents the indications, technique, and outcomes for transcatheter treatment of the acquired uterine AVMs. Study Design Literature databases were searched from 2003 to 2013 for eligible clinical studies, including the patient characteristics, procedural indication, results, complications, as well as descriptions on laterality and embolic agents utilized. Results A total of 40 studies were included comprising of 54 patients (average age of 33.4 years). TCE had a primary success rate with symptomatic control of 61% (31 patients) and secondary success rate of 91% after repeated embolization. When combined with medical therapy, symptom resolution was noted in 48 (85%) patients without more invasive surgical procedures. Conclusion Low-level evidence supports the role of TCE, including in the event of persistent bleeding following initial embolization, for the treatment of acquired uterine AVMs. The variety of embolic agents and laterality of approach delineate the importance of refining procedural protocols in the treatment of the acquired uterine AVM. Condensation A review on the management of patients with acquired uterine AVMs.
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Affiliation(s)
- Daniel J Yoon
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Megan Jones
- Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jamal Al Taani
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Catalin Buhimschi
- Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joshua D Dowell
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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12
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Brossat H, Frigo S, Langer B. [Successful expectant management of a uterine arteriovenous malformation]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:815-817. [PMID: 26584891 DOI: 10.1016/j.gyobfe.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Affiliation(s)
- H Brossat
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67100 Strasbourg, France.
| | - S Frigo
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67100 Strasbourg, France
| | - B Langer
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67100 Strasbourg, France
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