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相关的保留妊娠产物(RPOC)患者的管理更新。
一段6分钟的叙述视频讨论了EMV和AVM之间最近的区别。病因,症状,成像发现/解释,和基于症状的管理进行了详细的审查。因为这代表一个病例报告,根据45CFR46.102(l)的规定,它不符合研究的定义;因此,不需要机构审查委员会的批准。
三级转诊中心。
不完全流产后8周,一名28岁的gravida1,para0患者被带到RPOC的外部设施,月经过多,和血红蛋白的急剧减少。确诊子宫AVM后,她被转移到我们的机构接受进一步的治疗.
转移到我们中心后,超声显示RPOC,有明显的内部脉管系统,收缩期峰值速度>20cm/s。诊断为EMV。磁共振成像证实子宫内膜和子宫腔内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),然后进行抽吸D&C(图。2).宫腔镜检查在吸痰前后和刮宫后进行,子宫内膜表面有一个大的维管束。
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患者在术后2周时出现异常子宫出血症状和β-人绒毛膜促性腺激素试验阴性。
EMV患者的治疗取决于其症状的程度。如果出现明显出血,需要手术管理。先前的报告表明,EMV和RPOC患者应在D&C之前接受UAE,但是最近的研究表明,D&C可能在没有阿联酋的情况下启动,因为与RPOC相关的EMV可能是一种正常的一过性胎盘形成现象,并且出血风险比以前怀疑的要低。然而,术前明显出血和/或贫血的患者,我们建议阿联酋仍然应该被考虑。每个患者都需要根据症状进行个性化管理,标志,成像,以及未来生育计划。RPOC和EMV患者的理想管理仍有待确定。
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.
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.
Tertiary referral center.
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.
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.
None.
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.
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.