PDF(Pubmed)
Abstract：
Uterine arteriovenous malformations are a rare cause of puerperal haemorrhage, but their incidence is increasing due to both improved diagnosis and the more frequent use of uterine surgery in recent years. The use of ultrasound, both B-mode and Doppler, is recommended for diagnosis and follow-up, as it has been shown to be the simplest and most cost-effective method. Endometrial thickening associated with an anechoic and vascular intramiometrial structure is very useful for diagnosis and can help to exclude other causes of dysfunctional bleeding. Pulsed Doppler shows low-resistance vessels and high pulsatility indices with a high peak systolic velocity (PSV). In a healthy myometrium, the vessels have a peak systolic velocity of 9-40 cm/s and a resistance index between 0.6 and 0.8, whereas in the case of AVMs, the systolic and diastolic velocities are 4-6 times higher (PSV 25-110 cm/s with a mean of 60 cm/s and a resistance index of 0.27-0.75 with a mean of 0.41). For treatment, we must individualise each case, taking into account haemodynamic stability, the patient\'s reproductive wishes, and the severity of the AVM as assessed by its size and PSV.
摘要：
子宫动静脉畸形是产褥期出血的罕见原因，但是由于诊断的改善和近年来子宫手术的使用越来越频繁，它们的发病率正在增加。超声波的使用，B模式和多普勒,建议用于诊断和随访，因为它被证明是最简单和最具成本效益的方法。与无回声和血管肌层内结构相关的子宫内膜增厚对诊断非常有用，并且可以帮助排除功能失调性出血的其他原因。脉冲多普勒显示低阻力血管和高搏动指数，具有高峰值收缩期速度（PSV）。在健康的子宫肌层中，血管的收缩期峰值速度为9-40cm/s，阻力指数在0.6和0.8之间，而在AVM的情况下，收缩和舒张速度高4-6倍（PSV25-110cm/s，平均60cm/s，阻力指数为0.27-0.75，平均0.41）。为了治疗，我们必须个性化每个案例，考虑到血液动力学的稳定性，病人的生殖愿望，以及通过其大小和PSV评估的AVM的严重程度。
