Department of Obstetrics and Gynecology, Scripps Clinic, San Diego, California.
Department of Obstetrics and Gynecology, Scripps Clinic, San Diego, California.
Fertil Steril. 2021 Sep;116(3):912-914. doi: 10.1016/j.fertnstert.2021.05.097. Epub 2021 Jun 30.
To describe the etiology of arteriovenous malformations (AVM) and enhanced myometrial vascularity (EMV), and review updates in management for patients with retained products of conception (RPOC) associated with EMV through a case presentation.
A 6-minute narrated video discusses the recent distinction between EMV and AVM. The etiology, symptoms, imaging findings/interpretation, and management based on symptoms are reviewed in detail. As this represents a single case report, it does not meet the definition of research according to the regulations at 45 CFR 46.102(l); therefore, institutional review board approval was not required.
Tertiary referral center.
PATIENT(S): Eight weeks after suction dilation and curettage (D&C) for an incomplete abortion, a 28-year-old gravida 1, para 0 patient presented to an outside facility with RPOC, menorrhagia, and an acute decrease in hemoglobin. After uterine AVM was diagnosed, she was transferred to our facility for further care.
INTERVENTION(S): After transfer to our center, ultrasound demonstrated RPOC, with prominent internal vasculature containing peak systolic velocity >20 cm/s. A diagnosis of EMV was made. Magnetic resonance imaging confirmed a prominent serpentine vessel at the endometrium and RPOC within the uterine cavity (Fig. 1). Due to her anemia, she underwent uterine artery embolization (UAE) followed by suction D&C (Fig. 2). Hysteroscopy was performed before and after suction D&C and after curettage, a large vascular bundle was appreciated at the surface of the endometrium.
MAIN OUTCOME MEASURE(S): None.
RESULT(S): The patient presented to the clinic 2 weeks postoperatively with the resolution of abnormal uterine bleeding symptoms and a negative β-human chorionic gonadotropin test.
CONCLUSION(S): Management of patients with EMV is dependent on the extent of their symptoms. If significant bleeding is present, surgical management is required. Previous reports suggested that patients with EMV and RPOC should undergo UAE before D&C, but more recent studies suggest that D&C may be initiated without UAE, as EMV associated with RPOC may be a normal transient placentation phenomenon and have less risk of hemorrhage than previously suspected. However, in patients with significant preoperative bleeding and/or anemia, we propose that UAE should still be considered. Each patient requires individualized management based on symptoms, signs, imaging, and plans for future fertility. The ideal management of patients with RPOC and EMV remains to be determined.
描述动静脉畸形（AVM）和增强的子宫血管性（EMV）的病因，并通过病例报告回顾与 EMV 相关的妊娠残留物（RPOC）患者的治疗更新。
一段 6 分钟的旁白视频讨论了 EMV 和 AVM 之间的最新区别。详细回顾了病因、症状、影像学发现/解读以及基于症状的治疗。由于这只是一个单一的病例报告，根据 45 CFR 46.102(l)的规定，它不符合研究的定义；因此，不需要机构审查委员会的批准。
三级转诊中心。
人工流产不全刮宫（D&C）后 8 周，一位 28 岁的初产妇 1 次、经产妇 0 次出现 RPOC、月经过多和血红蛋白急性下降，在外院就诊。诊断为子宫 AVM 后，她被转至我院进一步治疗。
转至我院中心后，超声显示 RPOC，内部血管丰富，收缩期峰值速度>20 cm/s。诊断为 EMV。磁共振成像（MRI）确认子宫内膜有明显的蛇形血管和宫腔内 RPOC（图 1）。由于她贫血，进行了子宫动脉栓塞术（UAE），随后进行了 D&C（图 2）。在 D&C 前后和刮宫后进行了宫腔镜检查，发现子宫内膜表面有一大束血管。
无。
患者术后 2 周就诊，异常子宫出血症状缓解，β-人绒毛膜促性腺激素检测阴性。
EMV 患者的治疗取决于其症状的严重程度。如果有明显出血，需要手术治疗。以前的报告表明，EMV 伴 RPOC 患者应在 D&C 前行 UAE，但最近的研究表明，D&C 可在不进行 UAE 的情况下开始，因为与 RPOC 相关的 EMV 可能是一种正常的短暂胎盘形成现象，其出血风险低于以前的预期。然而，对于术前有明显出血和/或贫血的患者，我们建议仍应考虑 UAE。每位患者都需要根据症状、体征、影像学和未来生育计划进行个体化治疗。RPOC 和 EMV 患者的理想治疗方法仍有待确定。
