Kulshrestha Vidushi, Shivhare Swati, Meena Jyoti, Gamanagatti Shivanand, Singhal Seema, Singh Neeta, Kumar Sunesh, Dadhwal Vatsla
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
Turk J Obstet Gynecol. 2022 Jun 27;19(2):111-117. doi: 10.4274/tjod.galenos.2022.34683.
To analyse the outcome of patients with symptomatic arterio-venous malformation (AVM), formed following pregnancy and managed by uterine artery embolization (UAE).
This retrospective study was conducted after ethical approval and included 15 patients presenting with abnormal uterine bleeding following pregnancy, who were suspected to have an AVM which later was confirmed by angiography and managed with UAE. Presenting symptoms, post-UAE complications and subsequent fertility outcomes were noted. Follow-up period ranged from 6 months to 2.5 years.
The mean age was 28.4±3.82 years and mean parity was 1.3. Out of 15 cases, 9 (60%) presented after abortion, 4 (26.6%) after normal vaginal delivery and 2 (13.3%) after cesarean delivery; of these 10/15 (66.7%) patients had a history of curettage. The most common presenting symptom was continuous bleeding per-vaginum since the antecedent pregnancy in 9/15 (60%) patients and 6/15 (40%) patients had irregular bleeding. The mean duration of symptoms was 91±85.7 (30-360) days. For UAE, embolic agents used were polyvinyl alcohol (PVA) particles (300-500 μm) in 2 (13.3%), 30% glue injection in 3 (20%), the combination of PVA with glue injection in 4 (26.6%) and PVA with gelfoam in 6 (40%) patients. After UAE, bleeding responded within 3.6±0.97 (3-6) days in all but one patient who required repeat UAE one month later. All women resumed their normal menstrual cycle in 31.3±5.2 (24-42) days. Ten patients desired conception, of whom 5 (50%) conceived within 13.2±5.1 (6-19) months after UAE. Two women carried pregnancy to term, one underwent preterm cesarean for growth restriction with oligohydramnios. One patient had postpartum hemorrhage, which was managed medically. One had spontaneous abortion at 6 weeks gestation and the other is 13 weeks pregnant at present.
UAE is an effective treatment modality for the management of symptomatic post-pregnancy AVMs.
分析妊娠后形成并接受子宫动脉栓塞术（UAE）治疗的有症状动静脉畸形（AVM）患者的治疗结果。
本回顾性研究在获得伦理批准后进行，纳入15例妊娠后出现异常子宫出血、疑似患有AVM且后来经血管造影确诊并接受UAE治疗的患者。记录患者的症状表现、UAE术后并发症及后续生育结局。随访时间为6个月至2.5年。
患者平均年龄为28.4±3.82岁，平均产次为1.3。15例患者中，9例（60%）在人工流产后出现症状，4例（26.6%）在正常阴道分娩后出现症状，2例（13.3%）在剖宫产术后出现症状；其中10/15例（66.7%）患者有刮宫史。最常见的症状表现为9/15例（60%）患者自上次妊娠后持续阴道出血，6/15例（40%）患者有不规则出血。症状平均持续时间为91±85.7（30 - 360）天。在UAE治疗中，2例（13.3%）患者使用聚乙烯醇（PVA）颗粒（300 - 500μm）作为栓塞剂，3例（20%）患者注射30%的胶水，4例（26.6%）患者联合使用PVA与胶水注射，6例（40%）患者联合使用PVA与明胶海绵。UAE术后，除1例患者1个月后需重复UAE外，所有患者在3.6±0.97（3 - 6）天内出血得到控制。所有女性在31.3±5.2（24 - 42）天内恢复正常月经周期。10例患者有受孕意愿，其中5例（50%）在UAE术后13.2±5.1（6 - 19）个月内受孕。2例女性足月分娩，1例因胎儿生长受限合并羊水过少行早产剖宫产。1例患者产后出血，经药物治疗。1例患者在妊娠6周时自然流产，另1例目前妊娠13周。
UAE是治疗有症状的妊娠后AVM的有效治疗方式。
