Vandenbroucke L, Morcel K, Bruneau B, Moquet P-Y, Bauville E, Levêque J, Lavoue V
Pôle de gynécologie, obstétrique et médecine de la reproduction, service d'obstétrique, CHU Anne-de-Bretagne, 16 boulevard de Bulgarie, Rennes cedex 2, France.
Gynecol Obstet Fertil. 2011 Jul-Aug;39(7-8):469-72. doi: 10.1016/j.gyobfe.2011.05.008. Epub 2011 Jul 12.
Uterine arteriovenous malformations (AVM) may be responsible for vaginal bleeding potentially life-threatening. They are most often acquired following uterine trauma (curettage, cesarean section, artificial delivery/uterus examination) in association with pregnancy or gestational trophoblastic disease. We report three cases of patients having uterine AVM after curettage. The diagnostic management is important to avoid differential diagnoses (intra-uterine retention, hemangioma, gestational trophoblastic disease). It is based on serum hCG measurement and Doppler ultrasound, then confirmed on dynamic angio-MRI, which tends to replace angiography as first-line. The therapeutic management in cases of symptomatic AVMs is mostly embolization which offers the possibility for childbearing. Current data on subsequent pregnancies is reassuring even if they remain limited.
子宫动静脉畸形（AVM）可能导致危及生命的阴道出血。它们最常继发于与妊娠或妊娠滋养细胞疾病相关的子宫创伤（刮宫、剖宫产、人工分娩/子宫检查）之后。我们报告了3例刮宫后发生子宫AVM的患者。诊断管理对于避免鉴别诊断（宫内残留物、血管瘤、妊娠滋养细胞疾病）很重要。它基于血清人绒毛膜促性腺激素（hCG）测量和多普勒超声，然后通过动态血管造影磁共振成像（MRI）得以确诊，动态血管造影MRI正逐渐取代血管造影成为一线检查方法。有症状的AVM病例的治疗管理大多采用栓塞术，这种方法为生育提供了可能。关于后续妊娠的现有数据令人安心，尽管仍然有限。
