Interventional Treatment and Prognostic Analysis Initial Diagnosed of Pregnan-cy-Related Uterine Arteriovenous Malformations
10.3969/j.issn.1003-6946.2025.09.013
- VernacularTitle:初步诊断为妊娠相关子宫动静脉畸形患者行介入治疗及预后分析
- Author:
Qian LIU
1
;
Ping PENG
1
;
Weilin CHEN
1
Author Information
1. 中国医学科学院北京协和医院妇产科国家妇产疾病临床医学研究中心,北京 100730
- Publication Type:Journal Article
- Keywords:
Pregnancy-related uterine arteriovenous malformation;
Uterine artery embolization;
Arteriovenous fistula;
Medical therapy
- From:
Journal of Practical Obstetrics and Gynecology
2025;41(9):754-759
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the safety,efficacy,and prognosis of interventional treatment for pregnan-cy-related uterine arteriovenous malformations(UAVM).Methods:A retrospective analysis was conducted of the clinical data from 8 patients with pregnancy-associated UAVM who underwent interventional therapy after initial di-agnosis by ultrasound at Peking Union Medical College Hospital between February 1,2016,and January 4,2024.Results:All 8 patients underwent ultrasound examination,and color Doppler imaging revealed abundant blood flow signals within the lesions,presenting a high-velocity and low-resistance blood flow spectrum.The median age of patients was 29 years,with termination of pregnancy occurring at 7-38 weeks of gestation.Clinical manifesta-tions included persistent irregular vaginal bleeding in 2 cases(25.0％),"on-off"hemorrhage in 2 cases(25.0％),acute massive vaginal bleeding(≥400 ml per episode)in 5 cases(62.5％),abdominal pain in 3 ca-ses(37.5％),secondary anemia in 4 cases(50.0％),and persistent elevation of serum β-hCG in 2 cases(25.0％).All 8 patients underwent uterine artery angiography.Postoperatively,5 cases were diagnosed with preg-nancy-related UAVM,with 1 case also complicated by a right ovarian arteriovenous fistula.The remaining 3 cases revealed only abnormal vascular clusters without early venous opacification.Bilateral uterine artery embolization(UAE)was performed in 4 cases,unilateral UAE(all right-sided)in 2 cases,and no UAE was performed in 2 ca-ses.Hysteroscopic lesion resection or curettage was performed in 3 cases,with 2 cases receiving adjuvant gona-dotropin-releasing hormone agonist(GnRH-a)therapy postoperatively.All 5 patients ultimately diagnosed with UAVM achieved hemostasis within 24 hours after UAE,with mild post-embolization syndrome observed in 1 case.During follow-up,only the patient with the concomitant ovarian arteriovenous fistula experienced recurrent sudden vaginal bleeding and subsequently underwent laparoscopic uterine lesion resection following GnRH-a therapy.Conclusions:UAE is the treatment of choice for pregnancy-related UAVM patients with complex or severe bleed-ing initially diagnosed by ultrasound.However,management should be tailored based on imaging and clinical fea-tures to balance therapeutic efficacy with fertility preservation.
