#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Enhanced myometrial vascularity


Authors: A. Richtárová 1 ;  K. Hlinecká 1 ;  Z. Lisá 1 ;  B. Boudová 1,3 ;  R. Kocián 1 ;  J. Kaván 2 ;  M. Mára 1
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze 1;  Radiodia gnostická klinika 1. LF UK a VFN v Praze 2;  Gynekologicko-porodnické oddělení, Oblastní nemocnice Trutnov a. s. 3
Published in: Ceska Gynekol 2022; 87(4): 249-254
Category: Case Report, Review Article
doi: https://doi.org/10.48095/cccg2022249

Overview

Objective: Case report of a gynecologically polymorbid patient with enhanced myometrial vascularity, and review of current scientific literature on incidence, dia­gnostic method, and management of this phenomenon. Case report: A 38-year-old patient that has been treated long-term for secondary sterility with a medical history of laparotomic cytoreduction surgery for adenomyosis and subsequent development and treatment of postoperative intrauterine adhesions. Currently presenting with enhanced myometrial vascularity after spontaneous abortion. For symptomatic prolonged course of the observation period without tendency for spontaneous regression and risk of acute hemorrhage, she was initially indicated for selective embolization of uterine arteries and consecutive definitive treatment via hysteroscopic resection. Conclusion: Due to low incidence and tendency for spontaneous resorption, early recognition, and correct management of enhanced myometrial vascularity, it still represents a medical challenge.

Keywords:

hysteroscopy – retained products of conception – enhanced myometrial vascularity – uterine artery embolization


Sources

1. 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. doi: 10.1016/j.ajog.2015.12.024.

2. O‘Rourke-Suchoff D, Benitez S, Higgins MC et al. Dia­gnosis and treatment of women with radiologic findings suspicious for uterine arteriovenous malformations. J Obstet Gynaecol 2021; 41 (5): 769–773. doi: 10.1080/01443 615.2020.1798905.

3. Timmerman D, Van den Bosch T, Peeraer K et al. Vascular malformations in the uterus: ultrasonographic dia­gnosis and conservative management. Eur J Obstet Gynecol Reprod Biol 2000; 92 (1): 171–178. doi: 10.1016/s0301-2115 (00) 00 443-7.

4. Groszmann YS, Healy Murphy AL, Benacerraf BR. Dia­gnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception. Ultrasound Obstet Gynecol 2018; 52 (3): 396–399. doi: 10.1002/uog.18954.

5. Van den Bosch T, Van Schoubroeck D, Timmerman D. Maximum peak systolic velocity and management of highly vascularized retained products of conception. J Ultrasound Med 2015; 34 (9): 1577–1582. doi: 10.7863/ultra.15. 14.10050.

6. Van Schoubroeck D, Van den Bosch T, Scharpe K et al. Prospective evaluation of blood flow in the myometrium and uterine arteries in the puerperium. Ultrasound Obstet Gynecol 2004; 23 (4): 378–381. doi: 10.1002/uog. 963.

7. Van den Bosch T, Van Schoubroeck D, Lu C et al. Color Doppler and gray-scale ultrasound evaluation of the postpartum uterus. Ultrasound Obstet Gynecol 2002; 20 (6): 586–591. doi: 10.1046/j.1469-0705.2002.00851.x.

8. Timmerman D, Wauters J, Van Calenbergh S et al. Color Doppler imaging is a valuable tool for the dia­gnosis and management of uterine vascular malformations. Ultrasound Obstet Gynecol 2003; 21 (6): 570–577. doi: 10.1002/uog.159.

9. Van den Bosch T, Daemen A, Van Schoubroeck D et al. Occurrence and outcome of residual trophoblastic tissue: a prospective study. J Ultrasound Med 2008; 27 (3): 357–361. doi: 10.7863/jum.2008.27.3.357.

10. Lacheta J. Uterine adenomyosis: pathoge­nesis, dia­gnostics, symptomatology and treatment. Ceska Gynekol 2019; 84 (3): 240–246.

11. Alonso Pacheco L, Timmons D, Saad Naguib M et al. Hysteroscopic management of retained products of conception: a single center observational study. Facts Views Vis Obgyn 2019; 11 (3): 217–222.

12. Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982; 69 (3): 412–422. doi: 10.1097/00006534-198203000-00 002.

13. Grewal K, Al-Memar M, Fourie H et al. Natural history of pregnancy-related enhanced myometrial vascularity following miscarriage. Ultrasound Obstet Gynecol 2020; 55 (5): 676–682. doi: 10.1002/uog.21872.

14. Capmas P, Lobersztajn A, Duminil L et al. Operative hysteroscopy for retained pro­ducts of conception: efficacy and subsequent fertility. J Gynecol Obstet Hum Reprod 2019; 48 (3): 151–154. doi: 10.1016/j.jogoh.2018.12.005.

15. Thakur M, Strug MR, De Paredes JG et al. Ultrasonographic technique to differentiate enhanced myometrial vascularity/arteriovenous malformation from retained products of conception. J Ultrasound 2021; 25 (2): 379–386. doi: 10.1007/s40477-021-00574-y.

16. Picel AC, Koo SJ, Roberts AC. Trans­catheter arterial embolization with n-butyl cyanoacry­late for the treatment of acquired uterine vascular malformations. Cardiovasc Intervent Radiol 2016; 39 (8): 1170–1176. doi: 10.1007/ s00270-016-1328-z.

17. O‘Leary M, Sanders AP. Enhanced myometrial vascularity – the time has come for individualized treatment of focal uterine pathology. Fertil Steril 2021; 116 (3): 691–692. doi: 10.1016/ j.fertnstert.2021.06.059.

18. Timor-Tritsch IE, McDermott WM, Monteagudo A et al. Extreme enhanced myometrial vascularity following cesarean scar pregnancy: a new dia­gnostic entity. J Matern Fetal Neonatal Med 2021; 17: 1–12. doi: 10.1080/ 14767058. 2021.1897564.

19. Kaelin Agten A, Ringel N, Ramos J et al. Standardization of peak systolic velocity mea­surement in enhanced myometrial vascularity. Am J Obstet Gynecol 2016; 215 (6): 802–803. doi: 10.1016/j.ajog.2016.08.013.

20. 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. doi: 10.1007/s00270-016-1543-7.

21. Berkane N, Moutafoff-Borie C. Impact of previous uterine artery embolization on fertility. Curr Opin Obstet Gynecol 2010; 22 (3): 242–247. doi: 10.1097/GCO.0b013e328338c179.

22. Acharya J, Bancroft K, Lay J. Perforation of transverse colon: a catastrophic complication of uterine artery embolization for fibroids. Cardiovasc Intervent Radiol 2012; 35 (6): 1524–1527. doi: 10.1007/s00270-012-0349-5.

23. Dewdney SB, Mani NB, Zuckerman DA et al. Uteroenteric fistula after uterine artery embolization. Obstet Gynecol 2011; 118 (2 Pt 2): 434–436. doi: 10.1097/AOG.0b013e31821082a3.

24. Maheux-Lacroix S, Lemyre M, Laberge PY et al. Uterine artery embolization complicated by uterine perforation at the site of previous myomectomy. J Minim Invasive Gynecol 2012; 19 (1): 128–130. doi: 10.1016/j.jmig.2011.10.004.

25. Pandey B, Sunanda GV, Crowe P. Enteroute­rine fistula: a rare and unusual complication of uterine artery embolisation. J Obstet Gynaecol 2012; 32 (1): 32–33. doi: 10.3109/01443 615.2011.615417.

26. Mara M, Horak P, Kubinova K et al. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 2012; 38 (5): 823–831. doi: 10.1111/j.1447-0756.2011.01782.x.

27. Mara M, Maskova J, Fucikova Z et al. Midterm clinical and first reproductive results of a ran­domized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31 (1): 73–85. doi: 10.1007/s00270-007-9195-2.

28. Groszmann YS, Healy Murphy AL et al. Dia­g­­- nosis and management of patients with enhanced myometrial vascularity associated with retained products of conception. Ultrasound Obstet Gynecol 2018; 52 (3): 396–399. doi: 10.1002/uog.18954.

Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#