Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review

Abstract

Ultrasound imaging with appropriate knowledge of color Doppler features minimizes the use of inappropriate interventional procedures such as diagnostic curettage. UAE is effective in treatment, and rarely leads to complications.

Resolution of Uterine Arterio-Venous Malformation Followed by Uneventful Pregnancy after Administration of Gonadotropin Releasing Hormone Agonist Concomitantly with an Aromatase Inhibitor and Tranexamic Acid

“…Acute presentation may manifest as torrential vaginal bleeding, suggesting arterial origin and in such cases immediate intervention to prevent hemorrhagic shock and even death is frequently required. In a systematic review of 100 AVM, total abdominal hysterectomy was performed in 29 patients (29%) while spontaneous resolution of AVM occurred in six patients (6%) [1]. In addition, approximately 30% of patients with AVM require blood transfusion [2].…”

“…In the last 20 years conservative therapies have been introduced as alternatives to hysterectomy including intrauterine tamponade, a variety of medications and/or Uterine Artery Embolization (UAE) with varying degrees of resolution of the AVM [1].…”

“…In a 2011 systematic review of 100 uterine arteriovenous malformations from 85 publications, uterine artery embolization was the most common treatment option performed in 59 patients (59%). In 18 patients (18%), haemorrhage due to AVM recurred after UAE, and in 17 patients (17%) recurrence of AVM occurred after treatment with UAE [1]. But, in some reports, trans-arterial UAE was not successful as a result of technical difficulties or the risk of complications [3].…”

“…However, since the effect of UAE on fertility and pregnancy outcomes remains controversial and since there is unpredictable response of AVM to UAE with a recurrence rate of 17% [1], we explored other less invasive therapies to treat AVMs in women who wished to retain their fertility and/or their uterus. The rationale of using the combination of the three drugs described in the present case is based on clinical evidence and acquired experience as described below.…”

“…To preserve the uterus and/or fertility, case reports of conservative medical therapies with oral contraceptives, danazol, methylergonovine, and Gonadotropin Releasing Hormone Agonist (GnRH-a), as well as inter-ventional transarterial embolization have been reported with varying degrees of success [1]. In the present manuscript we describe complete resolution of an AVM treated with a combination of tranexamic acid, a GnRH agonist and an aromatase inhibitor.…”