A retrospective analysis of the characteristics of acquired uterine arteriovenous malformations associated with retained products of conception
Abstract
Objectives: To compare the clinical characteristics and imaging manifestations of retained products of conception (RPOC) with retained products of conception combined with uterine arteriovenous malformation (UAVM-RPOC), to provide a basis for the early identification and clinical treatment of UAVM-RPOC.
Material and methods: A retrospective analysis was conducted on women of reproductive age (89 cases) for retained products of conception. Among the cases, 28 were identified with UAVM-RPOC through ultrasound diagnosis, while 61 were diagnosed with RPOC. The clinical and imaging characteristics of the two groups of women were analyzed, and the treatment methods and prognosis of UAVM-RPOC were also analyzed.
Results: 71.43% women with UAVM-RPOC had a history of two or more previous pregnancies, which was significantly higher than the 45.8% observed in the RPOC group (p < 0.05). The median serum level of β-human chorionic gonadotropin (β-HCG) was 128.7 (16.32–977) mIU/mL. The median time for detecting RPOC in women was 23 days, while the median time to diagnose UAVM-RPOC was 39.5 days. In transvaginal sonography (TVS), 92.86% of women with UAVM-RPOC exhibited low-resistance (RI < 0.5) ultrasound manifestations of the lesion, which was significantly higher than that in the RPOC group (32.79%), p < 0.0001. The contrast-enhanced ultrasound (CEUS) features of UAVM-RPOC were characterized by early-stage lesions showing rapid enhancement, which was followed by a late-stage delay in the washout of the contrast agent compared to the myometrium, leading to sustained enhancement. Out of 28 cases, only one woman underwent hysteroscopic surgery following pre-treatment with uterine artery embolization; the remaining female did not receive pre-treatment, and the surgical success rate for all women was 100%.
Conclusions: Our study revealed the clinical and imaging characteristics of UAVM-RPOC. Transvaginal ultrasound is the preferred examination for diagnosing UAVM-RPOC, but for cases with rich local blood flow signals, further refinement with CEUS examination can be beneficial. The combined examination can better assess the depth of muscle layer infiltration of the lesion, further evaluate the risk level of UAVM-RPOC, and guide clinical treatment.
Keywords: UAVM-RPOCCEUSPROC
References
- Yazawa H, Soeda S, Hiraiwa T, et al. Prospective evaluation of the incidence of uterine vascular malformations developing after abortion or delivery. J Minim Invasive Gynecol. 2013; 20(3): 360–367.
- Hugues C, Le Bras Y, Coatleven F, et al. Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes. Eur J Radiol. 2015; 84(12): 2485–2491.
- Vandenbroucke L, Morcel K, Bruneau B, et al. Acquired uterine arteriovenous malformations. Gynecol Obstet Fertil. 2011; 39(7-8): 469–472.
- Timor-Tritsch IE, Haynes MC, Monteagudo A, et al. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations. Am J Obstet Gynecol. 2016; 214(6): 731.e1–731.e10.
- Hoveyda F, MacKenzie IZ. Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG. 2001; 108(9): 927–930.
- Takahashi H, Ohhashi M, Baba Y, et al. Conservative management of retained products of conception in the normal placental position: A retrospective observational study. Eur J Obstet Gynecol Reprod Biol. 2019; 240: 87–92.
- Hoang VT, Van HA, Trinh CT, et al. Uterine arteriovenous malformation: a pictorial review of diagnosis and management. J Endovasc Ther. 2021; 28(5): 659–675.
- Müngen E. Vascular abnormalities of the uterus: have we recently over-diagnosed them? Ultrasound Obstet Gynecol. 2003; 21(6): 529–531.
- Capmas P, Levaillant JM, Teig B, et al. Uterine arteriovenous malformation involving the whole myometrium. Ultrasound Obstet Gynecol. 2013; 41(6): 715–717.
- Ghai S, Rajan DK, Asch MR, et al. Efficacy of embolization in traumatic uterine vascular malformations. J Vasc Interv Radiol. 2003; 14(11): 1401–1408.
- Delplanque S, Le Lous M, Proisy M, et al. Fertility, pregnancy, and clinical outcomes after uterine arteriovenous malformation management. J Minim Invasive Gynecol. 2019; 26(1): 153–161.
- Ruiz Labarta FJ, Pintado Recarte MP, González Leyte M, et al. Uterine artery embolization of uterine arteriovenous malformation: a systematic review of success rate, complications, and posterior pregnancy outcomes. J Pers Med. 2022; 12(7).
- Gilbert A, Thubert T, Dochez V, et al. Angiographic findings and outcomes after embolization of patients with suspected postabortion uterine arteriovenous fistula. J Gynecol Obstet Hum Reprod. 2021; 50(7): 102033.
- Shim DaJ, Choi SJ, Jung JiM, et al. Uterine arteriovenous malformation with repeated vaginal bleeding after dilatation and curettage. Obstet Gynecol Sci. 2019; 62(2): 142–145.
- O'Donnell JM, Al-Shahi Salman R, Manuguerra M, et al. Quality of life and disability 12 months after surgery vs. conservative management for unruptured brain arteriovenous malformations: Scottish population-based and Australian hospital-based studies. Acta Neurochir (Wien). 2018; 160(3): 559–566.
- Dietrich CF, Nolsøe CP, Barr RG, et al. Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver-update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol. 2020; 46(10): 2579–2604.
- Stoelinga B, Juffermans L, Dooper A, et al. Contrast-Enhanced ultrasound imaging of uterine disorders: a systematic review. Ultrason Imaging. 2021; 43(5): 239–252.
- Woo J, Kahn B. Enhanced myometrial vascularity: case presentation and review. Fertil Steril. 2021; 116(3): 912–914.
- Zhang W, Cui S, Mao Z, et al. Effect of direct surgical treatment in pregnancy-related uterine arteriovenous malformation. BMC Pregnancy Childbirth. 2023; 23(1): 673.
- Gao F, Ma X, Xu Y, et al. Management of acquired uterine arteriovenous malformations associated with retained products of conception. J Vasc Interv Radiol. 2022; 33(5): 547–553.
- Shim DaJ, Choi SJ, Jung JiM, et al. Uterine arteriovenous malformation with repeated vaginal bleeding after dilatation and curettage. Obstet Gynecol Sci. 2019; 62(2): 142–145.
- Gao F, Ma X, Xu Y, et al. Management of acquired uterine arteriovenous malformations associated with retained products of conception. J Vasc Interv Radiol. 2022; 33(5): 547–553.
- Nakashololo T, Khan N, Dunn Z, et al. Uterine arteriovenous malformations, clinical and radiological considerations: A report of two cases. Radiol Case Rep. 2021; 16(7): 1924–1929.
- Bazeries P, Paisant-Thouveny F, Yahya S, et al. Uterine artery embolization for retained products of conception with marked vascularity: a safe and efficient first-line treatment. Cardiovasc Intervent Radiol. 2017; 40(4): 520–529.
- Goyal S, Goyal A, Mahajan S, et al. Acquired uterine arteriovenous malformation developing in retained products of conception: a diagnostic dilemma. J Obstet Gynaecol Res. 2014; 40(1): 271–274.
- Sahoo B, Jena SK, Mishra SK, et al. Uterine arteriovenous malformation with raised serum beta-human chorionic gonadotropin (β-hCG) levels: a diagnostic and therapeutic dilemma. Cureus. 2024; 16(7): e64209.
