Ishihara Tomoko, Kanasaki Haruhiko, Oride Aki, Hara Tomomi, Kyo Satoru
Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Izumo, Japan.
Womens Health (Lond). 2016 Nov;12(6):538-543. doi: 10.1177/1745505717692590. Epub 2017 Feb 10.
Postpartum uterine bleeding is not uncommon and is caused by a variety of obstetrical and gynecological disorders, such as retained placenta, dysfunctional bleeding, and endometrial polyps. Placental polyps and uterine arteriovenous malformation are disorders often encountered in cases of abnormal uterine bleeding in the late puerperal period. These patients may experience life-threatening bleeding and require prompt intervention based on the correct differential diagnosis. The optimal treatments for both diseases differ as follows: intrauterine curettage or transcervical resection are chosen for placental polyps, while total abdominal hysterectomy or uterine artery embolization is preferred for uterine arteriovenous malformation since intrauterine curettage or transcervical resection has the risk of massive bleeding. However, since placental polyp and uterine arteriovenous malformation have similar clinical characteristics, it is important to accurately identify and differentiate between them to ensure optimal therapy. We report here cases that were suggestive of placental polyp or uterine arteriovenous malformation. We discuss the differential diagnoses and treatments for both diseases based on a literature review and propose a novel algorithm for managing such patients.
产后子宫出血并不罕见，它由多种妇产科疾病引起，如胎盘残留、功能失调性出血和子宫内膜息肉。胎盘息肉和子宫动静脉畸形是产褥期晚期子宫异常出血病例中常遇到的疾病。这些患者可能会出现危及生命的出血情况，需要在正确的鉴别诊断基础上迅速进行干预。这两种疾病的最佳治疗方法如下：胎盘息肉选择刮宫术或经宫颈切除术，而子宫动静脉畸形则首选全腹子宫切除术或子宫动脉栓塞术，因为刮宫术或经宫颈切除术有大出血的风险。然而，由于胎盘息肉和子宫动静脉畸形具有相似的临床特征，准确识别和区分它们对于确保最佳治疗至关重要。我们在此报告提示胎盘息肉或子宫动静脉畸形的病例。我们基于文献综述讨论这两种疾病的鉴别诊断和治疗方法，并提出一种管理此类患者的新算法。
