Enhanced myometrial vascularity secondary to retained pregnancy tissue: time to stop misusing the term arteriovenous malformation

Purpose To construct and validate a nomogram to predict the risk of adverse events (intraoperative massive hemorrhage or retained products of conception) during the termination of Cesarean scar pregnancy (CSP). Method Data from patients diagnosed with CSP who underwent Dilation and Curettage (D&C) at two hospitals were retrospectively collected. This data formed both internal and external cohorts for analysis. The internal cohort was split randomly, with 70% of the data allocated to a training set and 30% to an internal validation set. The external cohort was used exclusively as the external validation set. LASSO and logistic regression were utilized to select variables and construct a nomogram. The nomogram's performance was assessed using various methods including C-index, calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA) to evaluate its ability for identification, calibration, and clinical effectiveness. Results The prediction nomogram incorporated several predictors, including scar thickness, type of CSP, gestational sac diameter, and blood flow. This nomogram exhibited strong discrimination, as evidenced by a C-index of 0.829 (95% confidence interval: 0.770–0.887). Moreover, even in the interval validation set, a high C-index value of 0.784 was achieved, and in the external validation set, it reached 0.833. Further assessment through calibration curve analysis, DCA, and CICA revealed a robust agreement between the nomogram's predictions and actual observations, underscoring its utility and reliability. Conclusion The validated nomogram effectively predicts adverse events in CSP, showing good discrimination and calibration, making it useful in clinical settings.

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Role of Hysteroscopy in the Management of Uterine Vascular Malformations with a Focus on Enhanced Myometrial Vascularity – A Review of Diagnosis and Treatment with the Suggested Algorithm

Shahulhameed,

Chern,

Wright

2024

Gynecology and Minimally Invasive Therapy

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Postpregnancy bleeding is common after failed pregnancy, termination of pregnancy, and postnatally after both vaginal and cesarean delivery. Pelvic ultrasound (US) is usually the initial imaging modality of choice to ascertain the cause when the bleeding is heavy or prolonged. When used in combination with Doppler studies, US can help differentiate retained products of conception (RPOC) from rarer uterine vascular malformations (UVM), including true arterial vascular malformations and areas of enhanced endometrial vascularity (EMV), which may themselves be associated with any RPOC present. While the management of RPOC is well established and has evolved from an almost universal surgical approach to increasingly more medical or expectant alternatives, clinical decisions over the management of a concurrent UVM are less clear and treatment options need to be individualized depending on features of the lesion and the clinical situation with hysteroscopy featured as an important modality, especially when dealing with EMV’s. In this review, we discuss the role of hysteroscopy in the treatment of enhanced myometrial vascularity with and without associated RPOC and propose a management algorithm.

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Enhanced myometrial vascularity secondary to retained pregnancy tissue: time to stop misusing the term arteriovenous malformation

Cited by 3 publications

References 21 publications

Multimodality imaging of acute gynecological emergencies—a pictorial essay

Multimodality imaging of acute gynecological emergencies—a pictorial essay

Predictive Nomogram of Ultrasound Indicators for the Termination Outcome of Cesarean Scar Pregnancy

Role of Hysteroscopy in the Management of Uterine Vascular Malformations with a Focus on Enhanced Myometrial Vascularity – A Review of Diagnosis and Treatment with the Suggested Algorithm

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