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Kamil H, Aboulkher MG, Anbarji A, Martini N, Adwan D. Modified compression sutures for treatment of asymptomatic uterine arteriovenous malformation in a low-resource setting: A case report. Int J Surg Case Rep 2024; 118:109678. [PMID: 38663286 PMCID: PMC11064609 DOI: 10.1016/j.ijscr.2024.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine arteriovenous malformation (UAVM) can be present at birth or acquired later, often after trauma like cesarean delivery. It can cause severe vaginal bleeding but may have no symptoms. What makes our case special, other than being a rare condition, is the surgical technique used. CASE PRESENTATION A 24-year-old woman came in with abdominal pain at 38 weeks pregnant. She had a cesarean delivery 13 months before. She had an uncomplicated repeat cesarean but bled heavily after from uterine atony. A 5 × 7 cm asymptomatic uterine AVM was found incidentally in the right uterine horn. After the transfusion, B-Lynch sutures were used to treat the atony and AVM. The patient recovered well after the sutures. Follow-up ultrasound showed the AVM got much smaller and no more bleeding. CLINICAL DISCUSSION While conventional approaches advocate hysterectomy or uterine artery embolization (UAE), our case, situated in a low-income setting, necessitated innovative strategies. With embolization unavailable, and surgery carrying inherent risks, the B-lynch Procedure emerged as a pragmatic choice. CONCLUSION Uterine AVM with no symptoms can happen after cesarean delivery. In low-resource settings, modified compression sutures can effectively treat heavy bleeding after delivery and shrink AVM size, avoiding hysterectomy.
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Affiliation(s)
- Hazem Kamil
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
| | - Mhd Ghazi Aboulkher
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Abdullah Anbarji
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Dema Adwan
- Obstetrics and Gynecology Hospital, Damascus University, Damascus, Syria
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Tak H, Lee KN, Ryu JW, Lee KY, Son GH. Danazol as a Treatment for Uterine Arteriovenous Malformation: A Case Report. J Pers Med 2023; 13:1289. [PMID: 37763057 PMCID: PMC10532834 DOI: 10.3390/jpm13091289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Uterine arteriovenous malformation (AVM) is associated with a risk of massive uterine bleeding. Although uterine artery embolization remains the first-line treatment for AVM, there has been a recent exploration of pharmacological options. Danazol is known to reduce blood flow to the uterus; however, our understanding of its therapeutic efficacy for AVM remains limited. Herein, we present the results of danazol use in patients with uterine AVM. We retrospectively reviewed the medical records of patients who received danazol for the treatment of AVM between January 2013 and November 2022. The cohort comprised 10 patients who developed AVM after dilatation and curettage (D&C), abortion, or cesarean section. Danazol was administered twice daily at a total dose of 400 mg/day, and was employed for AVM treatment in hemodynamically stable patients who provided consent and were devoid of massive bleeding. Outpatient follow-ups (ultrasound measurements of AVM size and symptom assessment) were performed every 2 weeks. AVM was successfully treated with danazol in most patients with no adverse event. Eight postabortal patients had complete resolution of AVM after an average of 45 days (range 14-70 days). Of two patients who developed AVM after a cesarean section, one experienced AVM reduction, and the other developed massive bleeding, requiring emergency uterine artery embolization. In light of these outcomes, danazol can be potentially prioritized over uterine artery embolization in the treatment of AVM after abortion in hemodynamically stable patients.
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Affiliation(s)
- Hyunjin Tak
- Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (H.T.); (J.-W.R.); (K.-Y.L.)
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon 35015, Republic of Korea;
| | - Ji-Won Ryu
- Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (H.T.); (J.-W.R.); (K.-Y.L.)
| | - Keun-Young Lee
- Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (H.T.); (J.-W.R.); (K.-Y.L.)
| | - Ga-Hyun Son
- Department of Obstetrics and Gynecology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea; (H.T.); (J.-W.R.); (K.-Y.L.)
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
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Adwan D, Taifour W, Reslan FH. A successful bilateral iliac arteries ligation as an emergency management to a life-threatening AVM bleeding: A case report and literature review. Int J Surg Case Rep 2023; 106:108022. [PMID: 37084555 PMCID: PMC10154729 DOI: 10.1016/j.ijscr.2023.108022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine arteriovenous malformation (AVM) is a defect due to direct connection between uterine arteries and veins, it has wide range of symptoms and severity, usually causes vaginal bleeding which may be mild or severe and may cause death in some rare cases. Diagnostic methods may include ultrasound, MRI, CT and/or angiography which reveal a high blood flow hypoechoic mass. Many options have been applied as management procedures, including invasive and noninvasive procedures, aiming to save patient life and stop bleeding or preserve fertility in the less severe cases. CASE PRESENTATION 21 years old primigravida patient developed episodes of severe vaginal bleeding due to AVM after complete molar pregnancy evacuation and chemotherapy, managed successfully by bilateral internal iliac artery ligation and applying compression sutures on the uterus and continuing with compound medical treatment, trying to preserve fertility and ability to get pregnant in the future. CLINICAL DISCUSSION We point out AVM types, its sings, symptoms and the diagnostic procedures. We discuss the bilateral iliac artery ligation and applying modified compression sutures on uterus as possible emergency managements to AVM when there is a threatening on life due to huge bleeding. We also mentioned the other surgical and medical treatments. CONCLUSION We confirm the importance of keeping AVM in mind as a possible diagnose when there is unknown cause vaginal bleeding. Consider doing bilateral iliac artery ligation and applying the modified compression sutures as emergency procedures to stop or reduce AVM bleeding.
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Affiliation(s)
- Dema Adwan
- Obstetrics and Gynecology Hospital, Damascus University, Damascus, Syria
| | - Wessam Taifour
- Obstetrics and Gynecology Hospital, Damascus University, Damascus, Syria.
| | - Fatima Haj Reslan
- Obstetrics and Gynecology Hospital, Damascus University, Damascus, Syria
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Habte R, Yosef A, Bedaiwy M. Medical Management of Uterine Arteriovenous Malformation: A Case Series. Eur J Obstet Gynecol Reprod Biol 2022; 274:48-55. [PMID: 35580531 DOI: 10.1016/j.ejogrb.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/29/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND There has been increasing interest in medical management of uterine Arteriovenous Malformations (AVMs) in hemodynamically stable patients as a means of decreasing the need for invasive treatment that may impact fertility. CASES Amongst six cases of sonographically diagnosed uterine AVM managed medically with combined oral contraceptive pills or medroxyprogesterone acetate, three experienced complete resolution and three experienced partial resolution. Amongst those with complete resolution, all had a subsequent pregnancy that had no complication attributable to previous AVM or medical therapy. Amongst those with partial resolution, one is currently pregnant, one remains on therapy, and one has discontinued treatment with resumption of normal menses. CONCLUSION Medical management is effective in completely or partially resolving uterine AVMs. Subsequent pregnancies in this population are feasible and are not at higher risk for perinatal complications.
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Affiliation(s)
- Ruth Habte
- Department of Obstetrics and Gynecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Ali Yosef
- Assiut University, Postal 71111, Egypt
| | - Mohamed Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Women's Health Research Institute (WHRI), H214 - 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of British Columbia, BC Women's Hospital, C420 -4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
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Rosen A, Chan WV, Matelski J, Walsh C, Murji A. Medical treatment of uterine arteriovenous malformation: a systematic review and meta-analysis. Fertil Steril 2021; 116:1107-1116. [PMID: 34130801 DOI: 10.1016/j.fertnstert.2021.05.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. In addition, we evaluated for factors associated with treatment success and pregnancy outcomes after medical management. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Thirty-two studies representing 121 premenopausal women with medically-treated uterine AVM were identified via database searches of MEDLINE, Embase, Web of Science, and cited references. INTERVENTION(S) Medical treatment with progestins, gonadotropin-releasing hormone agonists (GnRH-a), methotrexate, combined hormonal contraception , uterotonics, danazol, or combination of the above. MAIN OUTCOME MEASURE(S) Primary outcome of treatment success was defined as AVM resolution without subsequent procedural interventions. Secondary outcome was treatment complication (readmission or transfusion). RESULT(S) The overall success rate of medical management was 88% (106/121). After adjusting for clustering effects, success rates for progestin (82.5%; 95% confidence interval [CI], 70.1%-90.4%), GnRH-a (89.3%; 99% CI, 71.4%-96.5%) and methotrexate (90.0%; 99% CI, 55.8%-98.8%) were significantly different from the null hypothesis of 50% success. The agents with the lowest adjusted proportion of complications were progestins (10.0%; 99% CI, 3.3%-26.8%) and GnRH-a (10.7%; 99% CI, 3.5%-28.4%). No clinical factors were found to predict treatment success. Twenty-six subsequent pregnancies are described, with no reported recurrences of AVM. CONCLUSION(S) Medical management for uterine AVM is a reasonable approach in a well selected patient. These data should be interpreted in the context of significant publication bias.
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Affiliation(s)
- Adam Rosen
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Wilson Ventura Chan
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Chris Walsh
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Hammad R, Nausheen S, Malik M. A Case Series on Uterine Arteriovenous Malformations: A Life-Threatening Emergency in Young Women. Cureus 2020; 12:e9410. [PMID: 32864239 PMCID: PMC7449621 DOI: 10.7759/cureus.9410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Uterine arteriovenous malformation (AVM) is a rare condition, with few cases reported in the literature. Despite being rare, it is a potentially life-threatening condition in women of child-bearing age. It should be considered in the differential diagnosis of prolonged or irregular vaginal bleeding, which, otherwise, can lead to critical complications ending up in severe morbidity and mortality. This case series describes four cases of young Asian women aged between 33 and 38 years who presented with irregular vaginal bleeding. Trans-abdominal ultrasound of the pelvis showed increased vascularity with multi-directional blood flow in the uterus. Magnetic resonance imaging (MRI) confirmed an arteriovenous malformation in all cases. All cases remained stable through the diagnostic journey. Embolization of the arteriovenous malformation was performed successfully in three cases and one case was managed conservatively on hormones. Later, two of them conceived within a year and had live births at term. The aim of reporting these cases is to share the common presentation of this condition and our experience in making the diagnosis and treatment of such patients. Although a few cases are reported world over, none was reported earlier from Pakistani Asian women.
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Affiliation(s)
- Rabia Hammad
- Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, PAK
| | - Sidrah Nausheen
- Obstetrics and Gynecology, Aga Khan University Hospital, Karachi, PAK
| | - Mumtaz Malik
- Radiology, Aga Khan University Hospital, Karachi, PAK
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7
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Grewal K, Al-Memar M, Fourie H, Stalder C, Timmerman D, Bourne T. Natural history of pregnancy-related enhanced myometrial vascularity following miscarriage. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:676-682. [PMID: 31503383 DOI: 10.1002/uog.21872] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Our primary aim was to report the incidence of enhanced myometrial vascularity (EMV) in consecutive women attending our early pregnancy assessment unit, following first-trimester miscarriage. We aimed further to evaluate the clinical presentation and complications associated with expectant and surgical management of EMV in these women. METHODS This was a prospective cohort study conducted in a London teaching hospital between June 2015 and June 2018, including consecutive patients with an observation of EMV on transvaginal ultrasonography following first-trimester miscarriage. The diagnosis was made following the subjective identification of EMV using color Doppler ultrasonography and a peak systolic velocity (PSV) ≥ 20 cm/s within the collection of vessels. Women were followed up with repeat scans every 14 days. Management was expectant unless intervention was indicated because of excessive or prolonged bleeding, persistent presence of retained tissue in the endometrial cavity or patient choice. The final clinical outcome was recorded. Time to resolution of EMV was defined as the interval from detection of EMV until resolution. RESULTS During the study period, there were 2627 first-trimester fetal losses in the department and, of these, 40 patients were diagnosed with EMV, hence the incidence of EMV following miscarriage was 1.52%. All cases were associated with ultrasound evidence of retained products of conception (RPOC) at presentation (mean dimensions, 22 × 20 × 20 mm). Thirty-one patients opted initially for expectant management, of which 18 had successful resolution without intervention, five were lost to follow-up and eight subsequently had surgical evacuation due to patient choice. No expectantly managed case required emergency intervention. Nine patients chose surgical evacuation as primary treatment. No significant correlation was seen between PSV within the EMV at presentation and blood loss at surgery. Median PSV was 47 (range, 20-148) cm/s. The estimated blood loss in all cases managed surgically ranged from 20-300 mL. Presence of RPOC was confirmed in all specimens that were sent for analysis following surgery. For cases successfully managed expectantly, the mean time to resolution was 48 (range, 21-84) days. In the nine cases managed surgically from the beginning, the mean time to resolution of EMV was 10.6 (range, 3-29) days. CONCLUSIONS This study suggests that EMV is an uncommon finding following miscarriage and is associated with the presence of RPOC. Expectant management was a safe option in our cohort, with minimal bleeding, although it was associated with protracted time to resolution. In patients who opted for surgery, the maximum blood loss was 300 mL and no patient required blood transfusion or embolization. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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MESH Headings
- Abortion, Spontaneous/diagnostic imaging
- Adult
- Female
- Humans
- Incidence
- London
- Myometrium/blood supply
- Myometrium/diagnostic imaging
- Neovascularization, Pathologic/diagnostic imaging
- Neovascularization, Pathologic/epidemiology
- Neovascularization, Pathologic/etiology
- Placenta, Retained/diagnostic imaging
- Placenta, Retained/etiology
- Pregnancy
- Pregnancy Trimester, First
- Prospective Studies
- Ultrasonography, Doppler, Color
- Ultrasonography, Prenatal
- Watchful Waiting
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Affiliation(s)
- K Grewal
- Tommy's National Centre for Miscarriage Research, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - M Al-Memar
- Tommy's National Centre for Miscarriage Research, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - H Fourie
- Tommy's National Centre for Miscarriage Research, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - C Stalder
- Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
- Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, London, UK
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
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Vilos AG, Oraif A, Machado M, Abu-Rafea B, Vilos GA. Resolution of Uterine Arteriovenous Malformation and Maintenance of Reproduction in 20 Women Treated with a GnRH Agonist Concomitantly with an Aromatase Inhibitor and Tranexamic Acid. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:772-781. [DOI: 10.1016/j.jogc.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 10/27/2022]
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9
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Brossat H, Frigo S, Langer B. [Successful expectant management of a uterine arteriovenous malformation]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:815-817. [PMID: 26584891 DOI: 10.1016/j.gyobfe.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Affiliation(s)
- H Brossat
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67100 Strasbourg, France.
| | - S Frigo
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67100 Strasbourg, France
| | - B Langer
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67100 Strasbourg, France
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Abstract
We present the case of a 54-year-old woman with intermittent right-sided abdominal pain. Ultrasound scans showed an unusual vascular appearance of the uterus with a thinned endometrium. Contrast CT led to a strong suspicion of an arteriovenous malformation of the uterus. The patient was successfully treated with a hysterectomy with salpingo-oophorectomy.
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Affiliation(s)
- Nazera Dodia
- Medical School, University of Manchester, Manchester, UK
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11
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Raherinantenaina F, Rajaonanahary TMA, Randriamandrato TAV, Rakoto Ratsimba HN. [Successful management of an acquired uterine arteriovenous malformation by selective ligation of the internal iliac artery]. ACTA ACUST UNITED AC 2015; 40:182-6. [PMID: 25778842 DOI: 10.1016/j.jmv.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/08/2015] [Indexed: 10/23/2022]
Abstract
Uterine arteriovenous malformations can be congenital or acquired. When acquired, they result from abnormal arteriovenous communication between one or more uterine arteries and a myometrial and/or endometrial venous plexus, without the interposition of a vascular nidus. Arteriovenous malformations are composed of a tortuous net of fragile low-resistant arteriovenous shunts. Uterine arteriovenous malformations create a rare and potentially life-threatening condition. The method of treatment is determined by symptoms, desire for future fertility, extent, and location of the malformation. The first treatment option for uterine arteriovenous malformation is hysterectomy, and the second option is uterine artery embolization. Selective ligation of the vessels supplying the malformation is an effective treatment option when conservative methods have failed. The present report describes a patient whose uterine arteriovenous malformation was successfully managed by selective ligation of the internal iliac artery.
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Affiliation(s)
- F Raherinantenaina
- Service de chirurgie générale et vasculaire, CHU/HUJRA, BP 4150, Antananarivo, Madagascar.
| | - T M A Rajaonanahary
- Service de chirurgie générale et vasculaire, CHU/HUJRA, BP 4150, Antananarivo, Madagascar
| | | | - H N Rakoto Ratsimba
- Service de chirurgie générale et vasculaire, CHU/HUJRA, BP 4150, Antananarivo, Madagascar
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12
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Uterine intramural persistent mole: A case report following molar pregnancy evacuation with arteriovenous malformation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Oride A, Kanasaki H, Miyazaki K. Disappearance of a uterine arteriovenous malformation following long-term administration of oral norgestrel/ethinyl estradiol. J Obstet Gynaecol Res 2014; 40:1807-10. [DOI: 10.1111/jog.12370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/05/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Aki Oride
- Department of Obstetrics and Gynecology; Shimane University School of Medicine; Izumo Shimane Japan
| | - Haruhiko Kanasaki
- Department of Obstetrics and Gynecology; Shimane University School of Medicine; Izumo Shimane Japan
| | - Kohji Miyazaki
- Department of Obstetrics and Gynecology; Shimane University School of Medicine; Izumo Shimane Japan
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14
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Kim T, Shin JH, Kim J, Yoon HK, Ko GY, Gwon DI, Yang H, Sung KB. Management of bleeding uterine arteriovenous malformation with bilateral uterine artery embolization. Yonsei Med J 2014; 55:367-73. [PMID: 24532505 PMCID: PMC3936651 DOI: 10.3349/ymj.2014.55.2.367] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM). MATERIALS AND METHODS Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies. RESULTS A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure- related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term. CONCLUSION Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.
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Affiliation(s)
- Taehwan Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea.
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15
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Singh N, Tripathi R, Mala YM, Tyagi S, Tyagi S, Singh C. Varied presentation of uterine arteriovenous malformations and their management by uterine artery embolisation. J OBSTET GYNAECOL 2013; 34:104-6. [PMID: 24359071 DOI: 10.3109/01443615.2013.816666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Uterine arteriovenous malformations are rare lesions which have a varied presentation that may range from the patient being asymptomatic to varying degrees of menorrhagia. It can be diagnosed by Doppler sonography but a strong index of suspicion is necessary. Management of this condition depends on presentation and available resources. In asymptomatic patients, we can leave the patients on regular follow-up as many lesions regress spontaneously. In patients with excessive haemorrhage not responding to embolisation or when facilities of embolisation are not available, hysterectomy needs to be done. Uterine artery embolisation should be considered the optimum treatment, as it has a high success rate coupled with few complications and also has fertility-preserving potential. Clinical follow-up usually suffices but sonography may occasionally be required.
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Affiliation(s)
- N Singh
- Departments of Obstetrics and Gynaecology
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16
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Chittawar PB, Patel K, Agrawal P, Bhandari S. Hysteroscopic diagnosis and successful management of an acquired uterine arteriovenous malformation by percutaneous embolotherapy. J Midlife Health 2013; 4:57-9. [PMID: 23833538 PMCID: PMC3702069 DOI: 10.4103/0976-7800.109641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Arteriovenous malformations are a rare but important cause of abnormal uterine bleeding in the midlife. Acquired uterine arteriovenous malformations are being increasingly diagnosed by transvaginal ultrasound, color Doppler and magnetic resonance angiography. We present a case where the suspected diagnosis was placental polyp or retained products of conception and hysteroscopy showed typical findings of uterine arteriovenous malformation, which was later, confirmed by magnetic resonance angiography. The patient underwent arterial embolization and recovered satisfactorily with resolution of hemorrhage and resumption of normal menstrual cycles. Abnormal bleeding due to arteriovenous malformations is worsened by curettage and hence its recognition is important in the management of abnormal uterine bleeding in the midlife.
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Affiliation(s)
- Priya B Chittawar
- Reproductive Medicine Unit, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Prospective Evaluation of the Incidence of Uterine Vascular Malformations Developing After Abortion or Delivery. J Minim Invasive Gynecol 2013; 20:360-7. [DOI: 10.1016/j.jmig.2012.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/15/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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Peitsidis P, Manolakos E, Tsekoura V, Kreienberg R, Schwentner L. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet 2011; 284:1137-51. [DOI: 10.1007/s00404-011-2067-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 08/11/2011] [Indexed: 02/07/2023]
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Syla BH, Fetiu SS, Tafarshiku SS. Transabdominal two- and three-dimensional color Doppler imaging of a uterine arteriovenous malformation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:376-378. [PMID: 21337661 DOI: 10.1002/uog.8918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- B H Syla
- Gynecologic Private Office Dr Bajrami, Ferizaj, Kosovo.
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Cura M, Elmerhi F, Bugnogne A, Palacios R, Suri R, Dalsaso T. Renal aneurysms and pseudoaneurysms. Clin Imaging 2011; 35:29-41. [DOI: 10.1016/j.clinimag.2009.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/03/2009] [Indexed: 01/16/2023]
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21
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Taylor E, Hitkari J. Identification hystéroscopique d’une malformation artérioveineuse utérine. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009. [DOI: 10.1016/s1701-2163(16)34368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Taylor E, Hitkari J. Hysteroscopic Identification of a Uterine Arteriovenous Malformation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:1117-8. [DOI: 10.1016/s1701-2163(16)34367-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Embolization of Uterine Arteriovenous Malformations Associated with Cyanotic Congenital Heart Disease. Cardiovasc Intervent Radiol 2009; 32:1075-9. [DOI: 10.1007/s00270-009-9573-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/14/2009] [Accepted: 03/18/2009] [Indexed: 12/12/2022]
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Yokomine D, Yoshinaga M, Baba Y, Matsuo T, Iguro Y, Nakajo M, Douchi T. Successful management of uterine arteriovenous malformation by ligation of feeding artery after unsuccessful uterine artery embolization. J Obstet Gynaecol Res 2009; 35:183-8. [DOI: 10.1111/j.1447-0756.2008.00875.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Yang PY, Hsu JC, Yeh GP, Hsieh CTC. Sonographic Features of Uterine Arteriovenous Malformations: Two and Three dimensional Findings. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60124-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Brun JL, André G, Descat E, Creux H, Vigier J, Dallay D. Modalités et efficacité des traitements médicaux et chirurgicaux devant des ménométrorragies organiques. ACTA ACUST UNITED AC 2008; 37 Suppl 8:S368-83. [DOI: 10.1016/s0368-2315(08)74778-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dar P, Karmin I, Einstein MH. Arteriovenous Malformations of the Uterus: Long-Term Follow-Up. Gynecol Obstet Invest 2008; 66:157-61. [DOI: 10.1159/000137687] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 03/31/2008] [Indexed: 11/19/2022]
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Banovac F, Lin R, Shah D, White A, Pelage JP, Spies J. Angiographic and Interventional Options in Obstetric and Gynecologic Emergencies. Obstet Gynecol Clin North Am 2007; 34:599-616, xiii. [DOI: 10.1016/j.ogc.2007.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lin AC, Hung YC, Huang LC, Chiu TH, Ho M. Successful Treatment of Uterine Arteriovenous Malformation with Percutaneous Embolization. Taiwan J Obstet Gynecol 2007; 46:60-3. [PMID: 17389192 DOI: 10.1016/s1028-4559(08)60109-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Uterine arteriovenous malformation (AVM) is a rare condition and can be life-threatening if not managed properly. We report a case that was diagnosed by typical ultrasound imaging and treated successfully with uterine arterial embolization. CASE REPORT A 28-year-old female, gravida 4, para 3, abortus 1, presented with massive vaginal bleeding 19 days after a termination of pregnancy due to fetal anomaly. After a dilatation and curettage 3 years previously, typical ultrasound image findings and a declining pattern of serum beta-hCG (human chorionic gonadotrophin), acquired AVM was highly suspected. The patient underwent bilateral uterine arterial embolization. Four weeks later, there was nearly complete resolution of the AVM and the patient's menstrual cycle was restored 6 weeks after embolization. CONCLUSION AVM can be diagnosed at an early stage with the aid of history taking and ultrasound. Percutaneous embolotherapy is a safe and effective treatment for AVM, especially when fertility preservation is desired.
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Affiliation(s)
- An-Chi Lin
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
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Morikawa M, Yamada T, Yamada H, Minakami H. Effect of Gonadotropin-Releasing Hormone Agonist on a Uterine Arteriovenous Malformation. Obstet Gynecol 2006; 108:751-3. [PMID: 17018490 DOI: 10.1097/01.aog.0000191584.28717.2c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of gonadotropin-releasing hormone agonist (GnRHa) on uterine arteriovenous malformations (AVM) is not well known. CASE A 37-year-old woman with a previous cesarean was diagnosed as having a uterine AVM after a spontaneous abortion with massive vaginal bleeding. The AVM decreased in size from 5.1 x 3.8 cm to 1.4 x 1.0 cm after 6 months of therapy with a GnRHa. Uterine artery embolization conducted after the GnRH therapy resulted in complete disappearance of the AVM. The patient's menstrual cycles and ovulation resumed 3 months after uterine artery embolization. CONCLUSION Gonadotropin-releasing hormone agonist therapy reduced the size of the uterine AVM. Thus, GnRHa therapy may be useful for uterine AVM in situations where uterine artery embolization must be postponed.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Sherer DM, Stimphil R, Hellmann M, Gorelick C, Serur E, Zigalo A, Jain M, Abulafia O. Transvaginal sonographic findings of isolated intramural uterine choriocarcinoma mimicking an interstitial pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:791-4. [PMID: 16731898 DOI: 10.7863/jum.2006.25.6.791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- David M Sherer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098, USA.
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Tsai CC, Cheng YF, Changchien CC, Lin H. Successful term pregnancy after selective embolization of a large postmolar uterine arteriovenous malformation. Int J Gynecol Cancer 2006; 16 Suppl 1:439-41. [PMID: 16515641 DOI: 10.1111/j.1525-1438.2006.00238.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Uterine arteriovenous malformations (AVM) are very uncommon disorders. Successful conservative treatment with subsequently conceived is rarely reported. We describe a 31-year-old woman with a complex and large postmolar AVM; she was successfully treated with transarterial selective embolization for a long history of repeated excessive vaginal bleeding and anemia. She resumed normal menstrual periods soon after treatment, and she subsequently conceived about 2 years later. A healthy male baby was delivered at 39 weeks of gestation via vaginal route. Selective embolization of a complex and large uterine AVM seems to be feasible for the treatment of uterine bleeding and preservation of reproductive capability.
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Affiliation(s)
- C-C Tsai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv 2005; 60:761-7. [PMID: 16250925 DOI: 10.1097/01.ogx.0000183684.67656.ba] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Uterine arteriovenous malformation (AVM) is a rare but potentially life-threatening condition. AVMs often present with intractable bleeding and commonly are seen in association with pregnancy and uterine trauma. Ultrasound is the most common form of initial investigation, and computed tomography and magnetic resonance imaging are being used with greater frequency. Despite this, angiography remains the gold standard for diagnostic evaluation. Embolization has become a more acceptable form of treatment and allows more invasive forms of treatment, particularly hysterectomy, to be avoided. Numerous medical therapies have also been used in the management of patients with uterine AVM. Reports of successful pregnancies after diagnosis and treatment of a uterine AVM are still uncommon, but increasingly good outcomes are being reported after successful treatment of a confirmed uterine AVM. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to describe the many and varied clinical manifestations of a uterine arteriovenous malformation (AVM), summarize the best ways to manage an acute hemorrhage from an AVM, and identify the current best way to diagnose an AVM.
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Affiliation(s)
- Rosalie M Grivell
- Department of Perinatal Medicine, Women's and Children's Hospital, Adelaide, South Australia 5006, Australia
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Rubod C, Mubiayi N, Robert Y, Vinatier D. Malformation artérioveineuse utérine. Une cause rare de métrorragies récidivantes. ACTA ACUST UNITED AC 2005; 33:511-3. [PMID: 16005663 DOI: 10.1016/j.gyobfe.2005.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 05/06/2005] [Indexed: 11/24/2022]
Abstract
Uterine arteriovenous malformation is a rare condition. We report a case with acquired arteriovenous malformation arising from the left uterine artery. She was diagnosed by color Doppler ultrasound and treated with a selective uterine artery embolization.
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Affiliation(s)
- C Rubod
- Service de gynécologie chirurgicale, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
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Maleux G, Timmerman D, Heye S, Wilms G. Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy. Eur Radiol 2005; 16:299-306. [PMID: 15977019 DOI: 10.1007/s00330-005-2799-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Revised: 03/22/2005] [Accepted: 05/02/2005] [Indexed: 11/30/2022]
Abstract
The purpose of this retrospective study is to assess the radiological and clinical outcome of transcatheter embolization of acquired uterine vascular malformations in patients presenting with secondary postpartum or postabortion vaginal hemorrhage. In a cohort of 17 patients (mean age: 29.7 years; standard deviation: 4.23; range: 25-38 years) 18 embolization procedures were performed. Angiography demonstrated a uterine parenchymal hyperemia with normal drainage into the large pelvic veins ("low-flow uterine vascular malformation") in 83% (n=15) or a direct arteriovenous fistula ("high-flow uterine vascular malformation") in 17% (n=3). Clinically, in all patients the bleeding stopped after embolization but in 1 patient early recurrence of hemorrhage occurred and was treated by hysterectomy. Pathological analysis revealed a choriocarcinoma. During follow-up (mean time period: 18.8 months; range: 1-36 months) 6 patients became pregnant and delivered a healthy child. Transcatheter embolization of the uterine arteries, using microparticles, is safe and highly effective in the treatment of a bleeding acquired uterine vascular malformation. In case of clinical failure, an underlying neoplastic disease should be considered. Future pregnancy is still possible after embolization.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
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Twenty-Eight-Year-Old Female With Persistent Vaginal Bleeding Post Dilatation and Curettage. ACTA ACUST UNITED AC 2004. [DOI: 10.1097/00130747-200412000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Castro-Aragon I, Aragon I, Urcuyo R, Abbott J, Levine D. Conservative management of a uterine arteriovenous malformation diagnosed in pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1101-1106. [PMID: 15284470 DOI: 10.7863/jum.2004.23.8.1101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Ilse Castro-Aragon
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Poli-Neto OB, Víbrio Neto JB, Nogueira AA, Reis FJCD. Embolização arterial seletiva em fístula arteriovenosa uterina pós-traumática. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000400017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Malformações arteriovenosas uterinas são pouco freqüentes. Os autores relatam um caso de fístula arteriovenosa traumática tratada por embolização seletiva das artérias uterinas, método que tem sido utilizado no controle da hemorragia pós-parto e hemorragia resultante de malignidade pélvica. Uma discussão é apresentada para ressaltar uma conseqüência da perfuração uterina e o controle da hemorragia sem sacrificar a fertilidade.
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Lowenstein L, Solt I, Deutsch M, Kerner H, Amit A. A Life-Threatening Event: Uterine Cervical Arteriovenous Malformation. Obstet Gynecol 2004; 103:1073-5. [PMID: 15121612 DOI: 10.1097/01.aog.0000109211.93819.4e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uterine cervical arteriovenous malformation is a rare cause of vaginal bleeding. CASE A 32-year-old multigravida presented with severe vaginal bleeding originating in the cervix, which resulted in a hypovolemic shock. Attempts to control the bleeding included hysterectomy, pelvic arterial embolization, and upper vaginectomy. Each proved unsuccessful. Histopathologic examination revealed an arteriovenous malformation. Despite local packing, suturing of the vault area, and brachytherapy to the vaginal vault, bleeding persisted. Treatment with GnRH agonist and tranexamic acid stopped the bleeding. CONCLUSION Severe vaginal bleeding can be the result of cervical arteriovenous malformation, and GnRH agonist may be used for treatment.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center and the Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Ghai S, Rajan DK, Asch MR, Muradali D, Simons ME, TerBrugge KG. Efficacy of Embolization in Traumatic Uterine Vascular Malformations. J Vasc Interv Radiol 2003; 14:1401-8. [PMID: 14605105 DOI: 10.1097/01.rvi.0000096761.74047.7d] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the efficacy of embolotherapy in patients with bleeding traumatic uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS A retrospective review of all patients who underwent pelvic arterial embolization at our institution between July 1992 and September 2002 was performed. Fifteen patients were diagnosed with a uterine vascular malformation on duplex ultrasonography and correlative MR imaging. Serial beta-human chorionic gonadotropin levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of the uterine arteries. Embolizations were performed with use of standard 4-5-F catheters and microcatheters when necessary. Embolic agents in the 25 procedures included glue only (n = 13), polyvinyl alcohol (PVA) particles and glue (n = 4), PVA particles (n = 2), Gelfoam (n = 2), coils (n = 1), PVA particles and coils (n = 1), glue and Gelfoam (n = 1), and glue and coils (n = 1). PVA particle size ranged from 350 to 1,000 micro m. Outcomes assessed were cessation of bleeding, persistence or resolution of the AVM, complications, and pregnancy after embolization. These were assessed by chart, laboratory, and imaging reviews. RESULTS A total of 25 embolization procedures were performed in 15 patients. Six patients required repeat embolization (one patient underwent embolization on six occasions; five patients had two embolization procedures each) for recurrence of bleeding. Sixteen procedures were performed on an elective basis and nine were performed on an emergent basis. The technical success rate of embolization was 100%. The clinical success rate was 93%: bleeding was controlled in 14 of 15 patients and one patient underwent a hysterectomy. Four of the 15 patients subsequently had a total of five uneventful intrauterine pregnancies carried to term. The 14 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 3-124 months) after treatment. Three patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. CONCLUSION Percutaneous embolotherapy is a safe and effective treatment for traumatic AVMs. This procedure allows for preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.
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Affiliation(s)
- Sangeet Ghai
- Division of Vascular and Interventional Radiology, Toronto Western Hospital, University Health Network-University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
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Successful Medical Treatment With Danazol After Failed Embolization of Uterine Arteriovenous Malformation. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200310000-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clarke MJ, Mitchell PJ. Uterine arteriovenous malformation: a rare cause of uterine bleeding. Diagnosis and treatment. AUSTRALASIAN RADIOLOGY 2003; 47:302-5. [PMID: 12890254 DOI: 10.1046/j.1440-1673.2003.01182.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of uterine arteriovenous malformation following a dilatation and curettage is presented. Initial diagnosis with colour and pulsed Doppler ultrasound and treatment with transcatheter arterial embolization are described.
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Affiliation(s)
- Michael J Clarke
- Bell Imaging Group, Department of Radiology, Western Hospital, Melbourne, Victoria, Australia.
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Timmerman D, Wauters J, Van Calenbergh S, Van Schoubroeck D, Maleux G, Van Den Bosch T, Spitz B. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:570-577. [PMID: 12808674 DOI: 10.1002/uog.159] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of this study was to assess the spontaneous outcome of uterine vascular malformations detected with ultrasonography and color Doppler, and to investigate the predictive value of color Doppler imaging as to which patients require invasive treatment. METHODS This was a prospective observational study conducted between January 1999 and February 2001 comprising all consecutive patients diagnosed with a uterine vascular malformation by ultrasonography and color Doppler imaging. Spectral analysis included measurement of flow velocities, pulsatility index (PI) and resistance index (RI). Close follow-up was arranged in all cases and the outcomes were recorded. RESULTS A total of 30 consecutive patients with uterine vascular malformations were included in the study. Spectral analysis of the vessels in the vascular malformations within the myometrium and endometrium revealed the presence of a low-impedance and high-velocity flow. The average values for PI, RI, peak systolic velocity (PSV) and time-averaged maximum velocity (TAMXV) were 0.50, 0.38, 0.63 m/s and 0.46 m/s, respectively. Eight patients (27%) eventually required embolization of the uterine arteries and three of them had true arteriovenous malformations confirmed at angiography. PSV values of >/= 0.83 m/s were associated with higher probabilities of further treatment, such as an embolization, whereas no vascular malformation with a PSV value < 0.39 m/s required embolization. CONCLUSION Conservative management is possible in more than two-thirds of patients presenting with uterine vascular malformations diagnosed by color Doppler sonography. Despite considerable overlap, PSV values appear to be useful in distinguishing between low- and high-risk patients.
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Affiliation(s)
- D Timmerman
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Nasu K, Fujisawa K, Yoshimatsu J, Miyakawa I. Uterine arteriovenous malformation: ultrasonographic, magnetic resonance and radiological findings. Gynecol Obstet Invest 2002; 53:191-4. [PMID: 12053106 DOI: 10.1159/000058373] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Uterine arteriovenous malformation (AVM) is a rare disease. However, it is important to make a rapid and precise diagnosis when it does occur, because life-threatening massive genital bleeding may occasionally be a symptom of this disease. In this case report, we present a case of uterine AVM diagnosed by means of ultrasonographic, magnetic resonance imaging (MRI) and angiographic studies. A 47-year-old Japanese woman was admitted complaining of severe hypermenorrhea that had been occurring for 5 years. Her last pregnancy was an uncomplicated term delivery at 32 years of age. Transvaginal and transabdominal ultrasonography demonstrated a thickening of the anterior wall of the uterine corpus with numerous cystic lesions. Color Doppler ultrasound, dynamic MRI and magnetic resonance angiography as well as pelvic angiography were useful for detecting the hypervascular lesions in this case. She was treated by a total hysterectomy and bilateral salpingo-oophorectomy under the diagnosis of uterine AVM. These noninvasive techniques should be performed initially when this rare disease is suspected.
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Affiliation(s)
- Kaei Nasu
- Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan.
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45
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Lai TH, Wu MH, Kuo PL, Cheng YC, Chang FM. Arteriovenous Malformation of the Uterus after Dilatation and Curettage Diagnosed by Three-dimensional Power Doppler Angiography. J Med Ultrasound 2002. [DOI: 10.1016/s0929-6441(09)60033-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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46
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Kwon JH, Kim GS. Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization. Radiographics 2002; 22:35-46. [PMID: 11796896 DOI: 10.1148/radiographics.22.1.g02ja0735] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Uterine curettage or surgical trauma can cause uterine vascular abnormalities, including pseudoaneurysms, acquired arteriovenous malformations (AVMs), arteriovenous fistulas, and rupture of vessels. Recognition of these abnormalities as the cause of hemorrhage is important, since these abnormalities can be treated safely and effectively with transcatheter arterial embolization but may be worsened by uterine curettage, precipitating massive uterine bleeding. Ultrasonography (US) is the most commonly performed initial imaging examination for evaluation of abnormal uterine bleeding. Color and duplex Doppler US allows convincing detection and diagnosis of these vascular abnormalities and helps differentiate vascular abnormalities that require embolization from nonvascular abnormalities. In cases of pseudoaneurysms, color and duplex Doppler US shows a blood-filled cystic structure with swirling arterial flow. In cases of AVMs, color Doppler US shows an intense vascular tangle, whereas duplex Doppler US shows low-resistance, high-velocity arterial flow. Cases of an AVM combined with a pseudoaneurysm demonstrate the findings of both AVMs and pseudoaneurysms. Transcatheter arterial embolization after angiography is the therapy of choice for these vascular abnormalities, with the advantage of retained reproductive capacity. Routine use of color and duplex Doppler US during examination of abnormal uterine bleeding is recommended to identify and characterize the vascular abnormality.
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Affiliation(s)
- Jung Hyeok Kwon
- Department of Diagnostic Radiology, Dongkang General Hospital, 123-3 Taehwa-dong, Ulsan 681-320, Korea.
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Rodríguez A, Escartín I, Riazuelo G, Zaragozano R. Malformación arteriovenosa uterina como raracausa de sangrado genital. RADIOLOGIA 2002. [DOI: 10.1016/s0033-8338(02)77757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Onoyama I, Fukuhara M, Okuma A, Watanabe Y, Nakamura G. Successful pregnancy after the noninvasive management of uterine arteriovenous malformation. Acta Obstet Gynecol Scand 2001; 80:1148-9. [PMID: 11846717 DOI: 10.1034/j.1600-0412.2001.801216.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- I Onoyama
- Department of Obstetrics and Gynecology, Hamanomachi Hospital, Fukuoka, Japan
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Hickey M, Fraser IS. Clinical implications of disturbances of uterine vascular morphology and function. Best Pract Res Clin Obstet Gynaecol 2000; 14:937-51. [PMID: 11141342 DOI: 10.1053/beog.2000.0136] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Menstrual disturbances are one of the most common problems presenting to the gynaecologist. In order for the endometrium to bleed, vessels must break down. Disruption in the regulation of endometrial vascular growth and function has been found in association with spontaneous and sex steroid-induced disturbances of menstrual bleeding. Although circulating oestrogens and progestogens influence the endometrial vessels, this effect appears to be indirect, and regulation is primarily via local factors. Deficient vasoconstriction and haemostasis with excessive fibrinolysis is seen in menorrhagia. Breakthrough bleeding in users of progestogen-only contraceptives is associated with increased superficial vascular fragility and disruptions in the supporting basement membrane. Blood vessels in uterine fibroids are abnormal in distribution and appearance. Adenomyosis is also commonly associated with menstrual disturbance, and alterations in vascular distribution suggest altered angiogenesis. Successful human embryo implantation requires endometrial vascular breakdown. Excessive thrombosis associated with the antiphospholipid syndrome may interfere with this re-modelling and compromise implantation. Arteriovenous malformations are a rare but important cause of excessive or irregular vaginal bleeding. Abundant vessels with abnormal morphology, associated with aberrant angiogenesis can be seen, and embolization of these vessels may be an effective conservative treatment. Improved understanding of the regulation of the uterine vasculature is likely to lead to targeted therapies to prevent unscheduled vascular breakdown and to control menstrual disturbance at an endometrial level.
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Affiliation(s)
- M Hickey
- Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, 2006, Australia
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50
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Wiebe ER, Switzer P. Arteriovenous malformations of the uterus associated with medical abortion. Int J Gynaecol Obstet 2000; 71:155-8. [PMID: 11064013 DOI: 10.1016/s0020-7292(00)00291-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Seven cases of uterine arteriovenous malformations associated with pregnancy were initially suspected by the history of prolonged bleeding after a medical abortion and then confirmed by color Doppler scanning. All cases were managed expectantly and resolved spontaneously. When AVMs required diagnosis by pathology or angiography, only the most severe cases would have been reported. Now that they can be recognized on ultrasound, it is possible that mild cases such as these will be found to be much more common.
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Affiliation(s)
- E R Wiebe
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
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