Uterine arteriovenous malformation complicating a scar ectopic pregnancy

Shafqat, Gulnaz; Khan, Anam; Basharat, Sundus

doi:10.1016/j.radcr.2022.02.063

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Ultimately, however, she developed a uterine AVM. While this has been described with other rare types of ectopic pregnancy, including interstitial and caesarean scar ectopic pregnancy, there appear to be no reports in the literature of this occurring in intramural ectopic pregnancy [ 8 , 9 ]. The patient underwent uterine artery embolisation due to the increased size of the AVM, which could potentially have affected her fertility.…”

Section: Discussionmentioning

confidence: 97%

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From intramural ectopic pregnancy to hysterectomy: A case report

Harris,

Awal,

Jacob-Rogers

et al. 2024

Case Reports in Women's Health

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Section: Discussionmentioning

confidence: 97%

“…Reported consequences of intramural ectopic pregnancies include uterine rupture, haemorrhage and hysterectomy. There are also case reports of other types of ectopic pregnancy (including interstitial and caesarean scar ectopic pregnancy) being associated with acquired arteriovenous malformations [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

From intramural ectopic pregnancy to hysterectomy: A case report

Harris,

Awal,

Jacob-Rogers

et al. 2024

Case Reports in Women's Health

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Ingrown chorionic villi of the first trimester as a result of a non-developing pregnancy in the post-cesarean scar, associated with the development of arteriovenous malformation: а clinical case

Kulabukhova,

Kondrashina,

Akinfiev

et al. 2024

Almanac of Clinical Medicine

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Background: Identification of residual chorionic tissue and ingrowing chorionic villi after uterine cavity curettage due to non-developing pregnancy, spontaneous abortions, and medical abortions has been a poorly studied problem. The most challenging is the differential diagnosis of this condition when the chorion grows into the scar from a caesarean section and is associated with arteriovenous malformations of the uterine wall. Nowadays, ultrasound has been recognized as the primary diagnostic method; however, the absence of specific echo-signs makes magnetic resonance imaging (MRI) and computed tomography (CT) the methods of choice and final diagnosis. Clinical case: This was a 39-year-old patient with a history of 3 caesarean sections and non-developing pregnancy and complete spontaneous miscarriage at 4 to 5 weeks of gestation in March 2021. Her final diagnosis was “growing of the chorionic villi of the first trimester of gestation into the myometrium to the entire depth of the uterine wall and up to the serous membrane without germination of the latter (placenta increta). At admission to the clinic in April 2021, she complained of pelvic pain, ongoing low intensity intermittent uterine bleeding, weakness, dizziness, and breast pain. The ultrasound revealed a mass in the uterine cavity. The MRI showed an incompetent post-cesarean uterine scar and residual chorionic tissue spreading to the uterine serosa, with peripheral arteriovenous structures of a neoangiogenous type. Multiaxial CT with angiography could not exclude an arteriovenous malformation within the uterine wall and residual chorionic tissue. During embolization, the angiograms showed the arteriovenous malformation in the projection of the uterus, with afferent vessels as bilateral uterine and cervicovaginal arteries and efferent vessels as bilateral parametric veins, internal iliac and ovarian veins. Based on the clinical and imaging pictures, embolization of the uterine arteries was performed as a first step and laparoscopic clipping of the uterine arteries and hysterectomy with fallopian tubes as a second step. Postoperatively the patient improved and beta-chorionic gonadotropin levels decreased. She was discharged home on the 5th day with no complaints. The clinical case demonstrates the important role of MRI and CT in the differential diagnosis and assessment of the zone and degree of chorionic villi ingrowth, aimed at determination of the possibility of organ-preserving treatment, or the need to perform a radical surgery should metroplasty be impossible. Conclusion: If an additional intrauterine mass is visualized by ultrasound examination after pregnancy termination, the method of choice and final diagnosis is MRI, which is performed to exclude the ingrown chorionic villi and to assess the degree of their invasion. MRI also allows for assessment of the viability of the post-cesarean scar and the presence of neoangiogenesis areas at the periphery of the ingrowth zone. CT is a method of clarifying diagnostics used to exclude vascular malformations of the uterine wall.

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Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Kulabukhova,

Nizyaeva,

Milovanov

et al. 2024

Almanac of Clinical Medicine

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Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

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Uterine arteriovenous malformation complicating a scar ectopic pregnancy

Cited by 3 publications

References 10 publications

From intramural ectopic pregnancy to hysterectomy: A case report

From intramural ectopic pregnancy to hysterectomy: A case report

Ingrown chorionic villi of the first trimester as a result of a non-developing pregnancy in the post-cesarean scar, associated with the development of arteriovenous malformation: а clinical case

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

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