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Uterine Arteriovenous Malformation: Case Series and Literature Review

机译:子宫动静脉畸形:病例系列和文献复习

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Background Uterine AV malformation is a rare cause of torrential post-abortal hemorrhage, which can present with varying grades of severity. Diagnosis requires a high degree of suspicion and is done with ultrasound and Doppler. Case Series In our institution, during the period 2008–2013, five cases of symptomatic uterine AVMs have been reported. All of them were in the reproductive age group (22–36?years), presenting with a history of miscarriage or termination of pregnancy for which curettage was done. The presentation was with recurrent bouts of torrential bleeding, some triggered by second curettage, and not controllable with regular measures. Diagnosis was by ultrasound-gray scale, color Doppler, and spectral Doppler. The time interval between the onset of symptoms and the primary curettage was 8–89?days; four patients underwent selective arterial embolization, and one patient opted for hysterectomy. On follow-up, all the four patients are presently free of symptoms; two of them conceived within 2?years of the procedure and carried the pregnancy to term—one resulting in a live-birth and the other intrauterine death. Conclusion Uterine AV malformation should be thought of as a differential diagnosis in all cases presenting with bleeding after miscarriage or curettage, since diagnosis is simple and treatment by selective arterial embolization saves morbidity of surgery and anesthesia, and more importantly reduces hospital stay and the absence from work.
机译:背景技术子宫AV畸形是引起流产后大出血的罕见原因,其严重程度不同。诊断需要高度怀疑,需要使用超声波和多普勒进行。病例系列在我们机构,2008-2013年期间,报告了5例有症状的子宫AVM病例。他们全部处于生殖年龄组(22-36岁),具有流产或终止妊娠的历史,为此进行了刮宫。表现为反复发作的山洪,有些是第二次刮宫引发的,并且不能通过常规措施控制。诊断通过超声灰度,彩色多普勒和频谱多普勒进行。症状发作与初次刮除之间的时间间隔为8-89天。 4例患者接受了选择性动脉栓塞,1例患者选择了子宫切除术。随访时,所有四名患者目前均无症状。他们中的两个人在手术后的2年内受孕,并将其怀孕到了足月,其中一个导致活产,另一个导致子宫内死亡。结论在所有流产或刮宫后出血的病例中,均应考虑将子宫AV畸形作为鉴别诊断,因为诊断简单且通过选择性动脉栓塞治疗可节省手术和麻醉的发生率,更重要的是可以减少住院时间和无工作。

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