Abstract：
Uterine arteriovenous malformations (UAVM) are rare vascular lesions characterized by an abnormal arteriovenous communication between the branches of uterine artery and the myometrial venous plexus. UAVM can be a serious cause of massive post-partum hemorrhage (PPH) leading to potentially life-threatening anemic shock. This review aims to summarize main experiences on clinical presentation and management of UAVM in the setting of unexplained PPH.
A systematic review of the literature in Scopus, PubMed and MEDLINE was conducted. A case report of a PPH UAVM-related in a patient managed at the authors\' center is also provided.
Eleven studies met the inclusion criteria. The mean age of cases was 30. In 3/11 cases, previous uterine surgeries were reported and 72.7% cases gave birth by cesarean section. Nine cases had a secondary PPH (24 h up to 12 week post-partum), whereas only one case had a primary PPH. Our case report had both a primary and a secondary PPH. Reported vaginal bleedings were profuse and blood loss entity ranged from 1000 to 2000 ml. In all cases a color Doppler ultrasound was performed first to suspect UAVM and in 10/11 cases a subsequent pelvic angiography confirmed the diagnosis of UAVM as leading cause of the unexplained PPH. In 81.8% cases a conservative management by uterine artery embolization (UAE) was adopted: bilateral UAE was always successful; in 1 out of 2 cases treated by unilateral UEA, emergency total hysterectomy was performed for a sudden hemodynamic instability.
Maternal mortality pregnancy-correlated is a major health concern worldwide, mostly due by PPH. UAVM should be considered in clinical practice among possible causes of unexplained PPH.
A systematic review of the literature in Scopus, PubMed and MEDLINE was conducted. A case report of a PPH UAVM-related in a patient managed at the authors\' center is also provided.
Eleven studies met the inclusion criteria. The mean age of cases was 30. In 3/11 cases, previous uterine surgeries were reported and 72.7% cases gave birth by cesarean section. Nine cases had a secondary PPH (24 h up to 12 week post-partum), whereas only one case had a primary PPH. Our case report had both a primary and a secondary PPH. Reported vaginal bleedings were profuse and blood loss entity ranged from 1000 to 2000 ml. In all cases a color Doppler ultrasound was performed first to suspect UAVM and in 10/11 cases a subsequent pelvic angiography confirmed the diagnosis of UAVM as leading cause of the unexplained PPH. In 81.8% cases a conservative management by uterine artery embolization (UAE) was adopted: bilateral UAE was always successful; in 1 out of 2 cases treated by unilateral UEA, emergency total hysterectomy was performed for a sudden hemodynamic instability.
Maternal mortality pregnancy-correlated is a major health concern worldwide, mostly due by PPH. UAVM should be considered in clinical practice among possible causes of unexplained PPH.
摘要：
子宫动静脉畸形（UAVM）是罕见的血管病变，其特征是子宫动脉分支与肌层静脉丛之间的动静脉连通异常。UAVM可能是大量产后出血（PPH）的严重原因，导致可能危及生命的贫血性休克。本综述旨在总结不明原因PPH中UAVM的临床表现和管理的主要经验。
对Scopus文献的系统回顾，进行了PubMed和MEDLINE。还提供了在作者中心管理的患者中PPHUAVM相关的病例报告。
11项研究符合纳入标准。病例的平均年龄为30岁。在3/11案例中，以前的子宫手术报告和72.7%的病例通过剖宫产分娩。9例继发PPH（产后24小时至12周），而只有一例有原发性PPH。我们的病例报告有原发性和继发性PPH。报告的阴道出血大量，失血实体范围为1000至2000毫升。在所有情况下，首先进行彩色多普勒超声检查以怀疑UAVM，在10/11例中，随后的骨盆血管造影证实UAVM的诊断是无法解释的PPH的主要原因。在81.8％的病例中，采用了子宫动脉栓塞（UAE）的保守治疗：双侧UAE总是成功的；在2例接受单侧UEA治疗的病例中，有1例，对突然的血流动力学不稳定进行了紧急全子宫切除术.
孕妇死亡率与妊娠相关是全球主要的健康问题。主要是由于PPH。UAVM应在临床实践中考虑原因不明的PPH的可能原因。
对Scopus文献的系统回顾，进行了PubMed和MEDLINE。还提供了在作者中心管理的患者中PPHUAVM相关的病例报告。
11项研究符合纳入标准。病例的平均年龄为30岁。在3/11案例中，以前的子宫手术报告和72.7%的病例通过剖宫产分娩。9例继发PPH（产后24小时至12周），而只有一例有原发性PPH。我们的病例报告有原发性和继发性PPH。报告的阴道出血大量，失血实体范围为1000至2000毫升。在所有情况下，首先进行彩色多普勒超声检查以怀疑UAVM，在10/11例中，随后的骨盆血管造影证实UAVM的诊断是无法解释的PPH的主要原因。在81.8％的病例中，采用了子宫动脉栓塞（UAE）的保守治疗：双侧UAE总是成功的；在2例接受单侧UEA治疗的病例中，有1例，对突然的血流动力学不稳定进行了紧急全子宫切除术.
孕妇死亡率与妊娠相关是全球主要的健康问题。主要是由于PPH。UAVM应在临床实践中考虑原因不明的PPH的可能原因。
