The noninvasive diagnosis and management of a uterine arteriovenous malformation

Flynn, Michael K.; Levine, Deborah

doi:10.1016/0029-7844(96)00122-6

Cited by 75 publications

(52 citation statements)

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“…Uma paciente com fístula arteriovenosa uterina foi tratada com maleato de metilergonovina, durante um ano. Além de controlar a hemorragia, foi observada, mediante estudo dopplerfluxométrico, significativa redução do fluxo arterial na fístula uterina, atribuída pelos autores à medicação 26 . Em outro caso utilizou-se o danazol, para reduzir a hemorragia e o fluxo sanguíneo uterino, contribuindo para a trombose da fístula.…”

Section: Resultsunclassified

Malformação arteriovenosa uterina após doença trofoblástica gestacional

Belfort¹,

Braga²,

Freire³

2006

Rev. Bras. Ginecol. Obstet.

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Objetivo: investigar a presença e resultados de malformações vasculares uterinas (MAVU) após doença trofoblástica gestacional (DTG). Métodos: estudo retrospectivo com inclusão de casos diagnosticados entre 1987 e 2004; 2764 pacientes após DTG foram acompanhadas anualmente com ultra-sonografia transvaginal e Doppler colorido no Centro de Neoplasia Trofoblástica Gestacional da Santa Casa da Misericórdia (Rio de Janeiro, RJ, Brasil). Sete pacientes tiveram diagnóstico final de MAVU baseado em análise ultra-sonográfica -índice de pulsatilidade (IP), índice de resistência (IR) e velocidade sistólica máxima (VSM) -e achados de imagens de ressonância nuclear magnética (RNM). Dosagens negativas de β-hCG foram decisivas para estabelecer o diagnóstico diferencial com DTG recidivante. Resultados: a incidência de MAVU após DTG foi 0,2% (7/2764). Achados ultra-sonográficos de MAVU: IP médio de 0,44±0,058 (extremos: 0,38-0,52); IR médio de 0,36±0,072 (extremos: 0,29-0,50); VSM média de 64,6±23,99 cm/s (extremos: 37-96). A imagem de RNM revelou útero aumentado, miométrio heterogêneo, espaços vasculares tortuosos e vasos parametriais com ectasia. A apresentação clínica mais comum foi hemorragia transvaginal, presente em 52,7% (4/7) dos casos. Tratamento farmacológico com 150 mg de acetato de medroxiprogesterona foi empregado para controlar a hemorragia, após a estabilização hemodinâmica. Permanecem as pacientes em seguimento, assintomáticas até hoje. Duas pacientes engravidaram com MAVU, com gestações e partos exitosos. Conclusão: presente sangramento transvaginal em pacientes com β-hCG negativo e história de DTG, deve-se considerar a possibilidade de MAVU e solicitar avaliação ultrasonográfica com dopplervelocimetria. O tratamento conservador é a melhor opção na maioria dos casos de MAVU pós-DTG. PALAVRAS-CHAVE:Malformação arteriovenosas; Neoplasias trofoblásticas; Ultra-sonografia Doppler; Imagem por ressonância magnética; Complicações na gravidez ABSTRACT Purpose: to investigate the presence and outcome of uterinevascular malformations (UVAM) after gestational trophoblastic disease (GTD). Methods: retrospective study of 2764 patients with GTD diagnosed from 1987 to 2004. All patients were followed up annually at the "Santa Casa da Misericórdia" Trophoblastic Disease Center (Rio de Janeiro, RJ, Brazil) with transvaginal ultrasonography (US) and color Doppler imaging. Seven patients had a final diagnosis of UVAM based on ultrasonographic analysis -pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) -and pelvic magnetic nuclear resonance (MNR) findings. Negative β-hCG values were of utmost importance to establish differential diagnosis with persistent GTD. Results: the incidence of UVAM after GTD was 0.2% (7/2764). US features of UVAM: PI mean 0.44±0,058 (extremes: 0.38-0.52); RI mean 0.36±0.072 (extremes: 0.29-0.50); PSV mean 64.6±23.99 cm/s (extremes: 37-96). MNR image showed a bulky uterus, myometrial inhomogeneity, serpiginous flow-related signal voids, and prominent parametrial vessels. The most com...

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Section: Resultsunclassified

Malformação arteriovenosa uterina após doença trofoblástica gestacional

Belfort¹,

Braga²,

Freire³

2006

Rev. Bras. Ginecol. Obstet.

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“…There are case reports in literature which highlight Colour Doppler as the primary non-invasive diagnostic test for arteriovenous malformations. [14][15][16] Five cases of endometrial carcinoma were predicted by TUCD. All the cases exhibited a low resistance flow.…”

Section: Discussionmentioning

confidence: 99%

To compare trans-vaginal ultrasound colour doppler (TUCD) with hysteroscopy and guided endometrial biopsy in diagnosing abnormal uterine bleeding

Choudhary

Ahmad

Agarwal

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONIn the women of child bearing age abnormal uterine bleeding (AUB) includes any change in menstrual period frequency, duration or amount of flow and intermenstrual bleeding.1 In postmenopausal women AUB includes vaginal bleeding of any cause 12 months or more after cessation of menses.2 Puberty and perimenopause are typically associated with anovulatory menstrual cycles. The immature hypothalamic-pituitary axis during puberty does not develop the necessary hormonal feedback to sustain the endometrium. Likewise, the decline of inhibin levels and rise in follicular stimulating hormone (FSH) levels reflect the loss of follicular activity and ABSTRACT Background: To compare trans-vaginal ultrasound Colour Doppler (TUCD) with hysteroscopy and guided endometrial biopsy in diagnosing abnormal uterine bleeding. Methods: A total of 50 consecutive and haemodynamically stable patients aged more than 40 years with abnormal uterine bleeding (AUB) were included in the study. Patients with pregnancy and probable cervical malignancy were excluded. All the patients were subjected to TUCD followed by hysteroscopic directed endometrial biopsy during the follicular phase of the menstrual cycle between 7 th and 11 th day to diagnose the underlying pathology. In postmenopausal female both TUCD and hysteroscopy were performed on any day. Results of both the procedures were compared. Results: The sensitivity and specificity of TUCD as compared to hysteroscopy in diagnosing polyp was found out to be 27.78% and 100%; for fibroid 100% and 84.4%; for endometrial hyperplasia 86.36% and 96.43%; for endometrial carcinoma 71.43% and 100%; and for endometrial atrophy 100% and 100%, respectively. After application of kappa statistics, the degree of agreement between the two diagnostic procedures was found to be 0.599 which was considered to be good. Conclusions: Conditions like fibroid, endometrial atrophy and cases of A-V malformation are better diagnosed with TUCD, while others like endometrial polyps, endometrial carcinoma are better detected on hysteroscopy. TUCD can diagnose most of the pathologies but not all, so it can be used as an adjunct to hysteroscopy to diagnose endometrial pathology, but can surely not replace hysteroscopy.

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“…8,17,20,21 Successful treatment of uterine vascular malformations with methylergonovine and subsequent pregnancy has also been reported. [22][23][24][25] Spontaneous resolution of uterine vascular malformations and subsequent pregnancy has also been reported in at least 5 cases. 8 Previously reported cases of uterine AVMs in pregnancy include a patient with an acute abdomen from intra-abdominal rupture at 38 weeks; the neonate survived, and the bleeding was controlled by oversewing the AVM during delivery.…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of a Uterine Arteriovenous Malformation Diagnosed in Pregnancy

Castro-Aragon

Aragon²,

Urcuyo³

et al. 2004

J of Ultrasound Medicine

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terine arteriovenous malformations (AVMs) are usually diagnosed in women with unexplained vaginal bleeding and are frequently life threatening. 1,2 When AVMs are diagnosed during pregnancy, there is concern that they could grow or bleed.3-6 To our best knowledge, there has been no reported case of an initial diagnosis of an asymptomatic AVM in a pregnant woman with a normal outcome. This case illustrates our experience with conservative management of a uterine AVM.Received February 26, 2004, from the Departments of Radiology (I.C.-A., D.L.) and Obstetrics and Gynecology (J.A.) Case ReportA 29-year-old woman, gravida 1, para 0, with a history of myomectomy 3 years earlier for a large left subserosal fibroid underwent routine first-trimester sonography in Costa Rica. Within the left posterior myometrial wall was a region of cystic spaces measuring 3 × 5 cm in greatest diameter that on color Doppler imaging was filled with turbulent flow with high systolic and diastolic velocities (Figure 1). With a peak systolic velocity (PSV) of 99 cm/s, resistive index (RI) of 0.49, and pulsatility index (PI) of 0.65, the diagnosis of a myometrial AVM was made. The patient was referred to our institution for a second opinion and counseling. An additional sonogram again showed findings of a uterine AVM. Of importance, a small portion of the placental edge was located near the vascular abnormality, but there was myometrium between the blood vessels and most of the placenta (Figure 2). The patient was counseled regarding risks of bleeding for the mother and the fetus during both the pregnancy and delivery. The patient recognized these risks but wanted to continue the pregnancy. A cesarean delivery was planned at term. Further discussions included the potential need for a uterine artery catheterization procedure to expedite embolization if necessary at the time of delivery and potential for a hysterectomy. The patient lived in a rural area of Costa Rica, and she temporarily moved near a tertiary care center for more rapid access to health care if needed.

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The noninvasive diagnosis and management of a uterine arteriovenous malformation

Abstract: Although there are case reports regarding treatment of uterine arteriovenous malformations by embolization performed by interventional radiology, to our knowledge, the noninvasive long-term management of a uterine arteriovenous malformation has not been reported.

Cited by 75 publications

References 4 publications

Malformação arteriovenosa uterina após doença trofoblástica gestacional

Malformação arteriovenosa uterina após doença trofoblástica gestacional

To compare trans-vaginal ultrasound colour doppler (TUCD) with hysteroscopy and guided endometrial biopsy in diagnosing abnormal uterine bleeding

Conservative Management of a Uterine Arteriovenous Malformation Diagnosed in Pregnancy

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