Objective

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.

Design

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.

Setting

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.

中文翻译：

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增强的子宫肌层血管：病例介绍和回顾

客观的

描述动静脉畸形 (AVM) 和增强的子宫肌层血管 (EMV) 的病因，并通过病例介绍回顾与 EMV 相关的受孕产物 (RPOC) 患者的管理更新。

设计

一段 6 分钟的旁白视频讨论了最近 EMV 和 AVM 之间的区别。详细回顾了病因、症状、影像学发现/解释和基于症状的管理。由于这是一份单一病例报告，因此不符合 45 CFR 46.102(l) 中规定的研究定义；因此，不需要机构审查委员会的批准。

环境

三级转诊中心。

耐心）

因不完全流产而进行的抽吸扩张和刮除术 (D&C) 八周后，一名 28 岁的妊娠 1、para 0 患者因 RPOC、月经过多和血红蛋白急剧下降就诊于外部机构。在诊断出子宫 AVM 后，她被转移到我们的机构接受进一步治疗。

干预措施

转移到我们中心后，超声显示 RPOC，显着的内部脉管系统包含峰值收缩速度 >20 cm/s。诊断为 EMV。磁共振成像证实子宫内膜和子宫腔内的 RPOC 有明显的蛇形血管（图 1）。由于她的贫血，她接受了子宫动脉栓塞术 (UAE)，然后是抽吸 D&C（图 2）。在抽吸 D&C 前后和刮宫后进行宫腔镜检查，在子宫内膜表面看到一个大血管束。

主要观察指标）

没有任何。

结果）

患者在术后 2 周就诊，异常子宫出血症状消失，β-人绒毛膜促性腺激素试验呈阴性。

结论

EMV 患者的管理取决于其症状的程度。如果出现大量出血，则需要手术治疗。以前的报告表明，EMV 和 RPOC 患者应在 D&C 前接受阿联酋，但最近的研究表明，D&C 可能在没有阿联酋的情况下开始，因为与 RPOC 相关的 EMV 可能是一种正常的短暂胎盘现象，出血风险比以前怀疑的要小。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。每个患者都需要根据症状、体征、影像学和未来生育计划进行个性化管理。RPOC 和 EMV 患者的理想管理仍有待确定。