子宫动静脉畸形治疗后的生育能力、妊娠和临床结局。
Fertility, Pregnancy, and Clinical Outcomes after Uterine Arteriovenous Malformation Management.
机构信息
Department of Obstetrics and Gynecology Gynecology (Drs. Delplanque, Le Lous, Joueidi, Bauville, Levêque, Lavoué, and Timoh) and Radiology (Drs. Proisy, Bauville, Rozel, Beraud, and Bruneau), Rennes Hospital, Rennes University 1, Rennes, France; Université de Rennes 1 (Drs. Delplanque, Le Lous, Proisy, Joueidi, Levêque, Lavoué, and Timoh), Rennes, France.
Department of Radiology, Rennes Hospital, Rennes University 1, Rennes, France; Université de Rennes 1 (Drs. Delplanque, Le Lous, Proisy, Joueidi, Levêque, Lavoué, and Timoh), Rennes, France.
出版信息
J Minim Invasive Gynecol. 2019 Jan;26(1):153-161. doi: 10.1016/j.jmig.2018.05.001. Epub 2018 May 14.
STUDY OBJECTIVE
To evaluate fertility, pregnancy, and clinical outcomes after uterine arteriovenous malformation (UAVM) management.
DESIGN
Single-center retrospective study (Canadian Task Force classification III).
SETTING
One referral center.
PATIENTS
Twenty-two patients with a UAVM diagnosed by magnetic resonance angiography or computed tomography angiography and managed by expectant management (EM) or uterine arterial embolization (UAE) during the study period were included.
INTERVENTIONS
Nine of 22 patients underwent first-intention EM and 13 first-line UAE. Three of 9 EM patients (33.3%) required emergency second-intention UAE for nonresolution of the UAVM and severe genital bleeding.
MEASUREMENTS AND MAIN RESULTS
To analyze fertility according to management approach, we defined 2 groups: EM only group (n = 6) and UAE group (n = 16; women who underwent first- or second-intention UAE). Overall, the median age was 29 years (range, 17-43). The mean follow-up after UAVM management was 39 months (range, 1-116). The success rate of the UAE procedure was 87.5% (14/16). Eight of 12 women (66.7%) who wished to conceive became pregnant: 2 of 5 (33.3%) in the EM group and 6 of 7 (85.7%) in the UAE group (p = 1). Overall, 11 patients (50%) conceived: 3 in the EM group (50%) and 8 in the UAE group (50%) (p = .9). The live birth rate was 36.4% (8/22) for the whole population. There were no miscarriages or ectopic pregnancies. The 8 women (72.7%) wishing to conceive who became pregnant all delivered: 1 by cesarean section and 7 by vaginal delivery. Median duration of pregnancy was 39 weeks and 5 days. The remaining 3 women (i.e., women who conceived but did not wish to become pregnant) had therapeutic abortions. One complication was experienced in the EM group (small for gestational age newborn) and none in the UAE group (p = .3). Limitations include retrospective design and small sample size.
CONCLUSION
UAE for UAVM is an effective and safe technique. It does not impair fertility, and obstetric prognosis is good.
研究目的
评估子宫动静脉畸形（UAVM）治疗后的生育能力、妊娠和临床结局。
设计
单中心回顾性研究（加拿大任务组分类 III 级）。
地点
一个转诊中心。
患者
22 例患者通过磁共振血管造影或计算机断层血管造影诊断为 UAVM，并在研究期间接受期待治疗（EM）或子宫动脉栓塞术（UAE）治疗。
干预措施
22 例患者中，9 例接受一线 EM 治疗，13 例接受一线 UAE 治疗。9 例 EM 患者中有 3 例（33.3%）因 UAVM 未缓解和严重生殖器出血需要紧急二线 UAE。
测量和主要结果
为了根据管理方法分析生育能力，我们定义了 2 组：仅 EM 组（n=6）和 UAE 组（n=16；接受一线或二线 UAE 的患者）。总体而言，中位年龄为 29 岁（范围 17-43 岁）。UAVM 治疗后平均随访 39 个月（范围 1-116 个月）。UAE 手术成功率为 87.5%（14/16）。12 名希望怀孕的妇女中有 8 名怀孕：EM 组 5 名中有 2 名（33.3%），UAE 组 7 名中有 6 名（85.7%）（p=1）。总体而言，11 名患者（50%）怀孕：EM 组 3 名（50%），UAE 组 8 名（50%）（p=0.9）。整个人群的活产率为 36.4%（8/22）。无流产或异位妊娠。8 名（72.7%）希望怀孕并已怀孕的妇女均分娩：1 例剖宫产，7 例阴道分娩。中位妊娠持续时间为 39 周零 5 天。其余 3 名妇女（即怀孕但不希望怀孕的妇女）进行了治疗性流产。EM 组发生 1 例并发症（小于胎龄儿新生儿），UAE 组无并发症（p=0.3）。局限性包括回顾性设计和样本量小。
结论
UAE 治疗 UAVM 是一种有效且安全的技术。它不会损害生育能力，且产科预后良好。
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