Postabortion Doppler Evaluation of the Uterus

Abstract

Objective. The aim of this study was to investigate the incidence and causes of uterine hypervascular lesions showing low-impedance, high-velocity flow on color Doppler sonography (CDS) after firsttrimester dilation and curettage (D&C). Methods. This was a prospective study of 65 consecutive women who underwent first-trimester termination of pregnancy. Color Doppler sonography of the uterus was performed on days 3 and 10 after D&C. If the myometrial hypervascularity (MH) persisted on day 10, a second D&C was performed, and then the patients were followed with weekly Doppler examinations. Results. In 16 of 65 women (24.6%), MH was detected with CDS on day 3 after D&C. In 3 cases, MH resolved spontaneously by postabortion day 10. In the remaining 13 patients, the second D&C performed on day 10 revealed retained products of conception (RPOC) in 8 patients (61.5%), a hydatidiform mole in 2 (15.4%), endometritis in 1 (7.7%), and no abnormality in 2 (15.4%). Complete resolution of the MH occurred in all cases. The mean period to the resolution of MH after the second D&C ± SD was 16.54 ± 11.06 days (range, 7-48 days). Univariate analysis revealed that gestational age at D&C (P = .012) and a history of any uterine surgery (P = .044) were significantly associated with postabortion MH. On binary logistic regression analysis, gestational age at D&C was the only independent predictive factor for MH (P = .016; odds ratio, 1.47; 95% confidence interval, 1.08-2.02). Conclusions. The presence of hypervascular areas within the myometrium is a common finding in the postabortion period, and in most cases, the cause of this finding is RPOC. Key words: abortion; color Doppler sonography; myometrial hypervascularity; uterus. he definitive diagnosis and management of postabortion and postpartum myometrial hypervascular lesions on Doppler sonography is challenging, particularly in patients with abnormal vaginal bleeding. A uterine arteriovenous malformation (AVM), a potentially life-threatening condition, is often considered in the differential diagnosis.1,2 However, an AVM of the uterus is a rare entity. In a cross-sectional study involving 385 consecutive women who underwent a transvaginal sonographic examination approximately 6 weeks after pregnancy, hypervascular areas within the myometrium were detected in 5% of women after term deliveries and in 18.9% after first-trimester miscarriages. 3In another study of 93 consecutive women in the puerperium after uncomplicated term singleton pregnancy, Van Schoubroeck et al 4 found that enhanced myometrial vascularity was observed in 50.5% of patients on postpar-

Imaging and hysteroscopic findings in a patient with postpartum hemorrhage caused by acquired uterine arteriovenous fistulas

“…22 A correct sonographic diagnosis is, thus, very crucal. 23 However, relying only on Doppler measurements could result in the overdiagnosis of an AVF, as increased vascularity in the endometrium, which resolves spontaneously in 1-2 weeks, can also be noted immediately post D&C. 24 With DSA, hypertrophied uterine arteries contributing to a large area of hypervascularity and rapid outflow into pelvic venous channels indicate the presence of a UAVF. 25 Although contrast medium-enhanced DSA has been the conventional criterion for standard diagnostic tests, its current use is rare; it is now predominantly used during embolization therapy.…”

Iatrogenic uterine injury leading to uterine arteriovenous malformation

“…Doppler studies show increased vascularity in the myometrium, with typical low-resistance and high-velocity waveforms. However, relying only on Doppler measurements may lead to overdiagnosis of AVM as increased vascularity in the endometrium is also seen immediately post D&C and resolves spontaneously in 1-2 weeks [7] . Timmerman et al.…”