Arteriovenous malformation as a consequence of a scar pregnancy

Rygh, Astrid Betten; Greve, Ole Jacob; Fjetland, Lars; Berland, Jannicke M.; Eggebø, Torbjørn Moe

doi:10.1080/00016340902971466

Cited by 28 publications

(16 citation statements)

References 12 publications

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“…However, a longer follow‐up period due to slower β‐hCG decrease should be expected when this management is selected. Underlying conditions, such as arteriovenous malformation, should be investigated when the bleeding persists and immediate surgical measures should be taken . The success rate of the intervention may decrease with advanced pregnancies (Case 4) and with an underlying condition, such as arteriovenous malformation (Case 2).…”

Section: Discussionmentioning

confidence: 99%

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Çok

Kalaycı

Özdemir

et al. 2014

J of Obstet and Gynaecol

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Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, which occurs in previous cesarean section scar tissue, with an incidence of 1 in 1800–3000 pregnancies. Transvaginal ultrasound‐guided local methotrexate (MTX) administration presents as a non‐systemic option with possible better penetration to the pregnancy site. We present the management of 18 patients with CSP solely by transvaginal ultrasound‐guided local MTX administration. All patients were treated with local MTX with a dose of 50 mg/m2. Eleven (61.1%) of the patients did not need any further intervention. Four patients (22.2%) were treated with additional single‐dose systemic MTX due to inadequate alteration in blood β‐human chorionic gonadotrophin levels. Three patients (16.7%) required hysteroscopy and/or laparotomy. We suggest that transvaginal ultrasound‐guided local MTX treatment may be considered as a first‐line treatment for CSP.

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Section: Discussionmentioning

confidence: 99%

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Çok

Kalaycı

Özdemir

et al. 2014

J of Obstet and Gynaecol

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“…More than half of these women have only had one prior cesarean delivery [5]. AVMs have been confirmed as arising from a prior cesarean scar ectopic implantation site [6]. This may result from failed obliteration of placental bed vessels in the absence of retained placental tissue.…”

Section: Resultsmentioning

confidence: 99%

The Role of Radical Surgery in the Management of Acquired Uterine Arteriovenous Malformation

Moulder¹,

Garrett²,

Salazar

et al. 2013

Case Rep Oncol

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Background: Acquired arteriovenous malformations (AVMs) can develop after uterine instrumentation. The increased risks of vascular changes, including abnormal placentation, after repeated cesarean sections are well studied. Herein, we describe a patient with delayed hemorrhage from a uterine AVM, following dilation and curettage for a cesarean scar pregnancy. Case: A 32-year-old G3P2 presented with a cesarean scar ectopic pregnancy managed with dilation and curettage, which incurred a 1,500-ml blood loss. Within 6 weeks, she returned with 2 episodes of vaginal bleeding. Initial angiography demonstrated a high-flow arteriovenous fistula, which was coiled. Vaginal hemorrhage recurred; repeat angiography demonstrated a large AVM. Gelfoam embolization of the bilateral internal iliac arteries reduced the vascularity of the AVM. The AVM's location, starting at the left lateral apex of the cesarean scar and extending into the parametrium, necessitated a radical hysterectomy. Pathologic examination revealed a placenta percreta extending into the parametrium. Conclusion: The prevalence of uterine AVMs has increased with the rise in surgical obstetrics. In patients with a failed prior interventional procedure, surgical management is necessary to prevent life-threatening hemorrhage. The location of the AVM within the abnormal uterine scar tissue requires familiarity with radical pelvic surgical techniques that are normally used in cancer surgery in order to definitively treat this delayed obstetrical complication.

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“…An uteroplacental neovascularization pattern in the CSP may be another important factor in the determination of which form of treatment is appropriate. An AVM must be regarded as a likely consequence of a CSP; the diagnosis can be confirmed by finding trophoblastic tissue and abnormally dilated vessels in the resected Cesarean scar 18…”

Section: Discussionmentioning

confidence: 99%

“…A literature review showed only two case reports of CSPs complicated with AVMs17, 18 (Table 1). On the other hand, β‐hCG levels do not support a diagnosis of an AVM 18. No stepwise treatment strategy for CSP or related complications, such as AVMs, has been published.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cesarean scar pregnancy: A rare cause of uterine arteriovenous malformation

Akbayır¹,

Gedikbaşı²,

Akyol³

et al. 2011

J of Clinical Ultrasound

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A 38-year-old gravida 4, para 2 woman with a history of two Cesarean sections and one curettage was referred to our hospital, because of painless vaginal bleeding and 6 weeks + 2 days of amenorrhea. The first diagnosis was Cesarean scar pregnancy, managed with methotrexate. Subsequently, an arteriovenous malformation developed, which was diagnosed with color Doppler imaging. The diagnosis was confirmed with angiography. Successful bilateral uterine artery embolization was performed with ethylene vinyl alcohol copolymer (Onyx), n-butyl-2-cyanoacrylate (Histoacryl), and gelfoam.

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Arteriovenous malformation as a consequence of a scar pregnancy

Cited by 28 publications

References 12 publications

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

The Role of Radical Surgery in the Management of Acquired Uterine Arteriovenous Malformation

Cesarean scar pregnancy: A rare cause of uterine arteriovenous malformation

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