Vilos Angelos G, Vilos George A, Hollett-Caines Jackie, Rajakumar Chandrew, Garvin Greg, Kozak Roman
The Fertility Clinic, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
The Fertility Clinic, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Hum Reprod. 2015 Jul;30(7):1599-605. doi: 10.1093/humrep/dev097. Epub 2015 May 6.
Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or acquired. Acquired AVMs may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease. The majority of acquired AVMs are encountered in women of reproductive age with a history of at least one pregnancy. Traditional therapies of AVMs include medical management of symptomatic bleeding, blood transfusions, uterine artery embolization (UAE) or hysterectomy. In this retrospective case series, we report our experience with AVM and UAE in five symptomatic women of reproductive age who wished to preserve fertility. Patients were 18-32 years old, and had 1-3 previous pregnancies prior to initial presentation. All patients were followed until their deliveries. All five patients delivered live births. Three of the five patients required two embolization procedures and one of these women required a subsequent hysterectomy. Two deliveries were at term and had normal weight babies and normal placenta. One woman had cerclage placed and developed chorioamnionitis at 34 weeks but had a normal placenta. Two pregnancies were induced <37 weeks for pre-eclampsia/b intrauterine growth restriction ± abnormal umbilical artery dopplers. The low birthweight were both <2000 g. Both placentas showed accelerated maturity and infarcts. All estimated blood losses were recorded as <500 cc. In conclusion, UAE may not be as effective at managing AVM as previously thought and should be questioned as an initial therapy in symptomatic women of reproductive age desiring fertility preservation.
子宫动静脉畸形（AVM）较为罕见，可分为先天性或后天性。后天性AVM可能由创伤、子宫手术操作、感染或妊娠滋养细胞疾病引起。大多数后天性AVM见于有至少一次妊娠史的育龄女性。AVM的传统治疗方法包括对有症状出血的药物治疗、输血、子宫动脉栓塞术（UAE）或子宫切除术。在这个回顾性病例系列中，我们报告了对五名希望保留生育能力的有症状育龄女性进行AVM和UAE治疗的经验。患者年龄在18至32岁之间，在首次就诊前有1至3次既往妊娠。所有患者均随访至分娩。所有五名患者均分娩活婴。五名患者中有三名需要进行两次栓塞手术，其中一名女性随后需要进行子宫切除术。两次分娩为足月产，婴儿体重正常，胎盘正常。一名女性放置了宫颈环扎术，在34周时发生绒毛膜羊膜炎，但胎盘正常。两次妊娠因子痫前期/胎儿宫内生长受限±脐动脉多普勒异常在37周前引产。低出生体重儿均<2000g。两个胎盘均显示成熟加速和梗死。所有估计失血量均记录为<500cc。总之，UAE在治疗AVM方面可能不如先前认为的有效，对于希望保留生育能力的有症状育龄女性，作为初始治疗方法应受到质疑。
