Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management.
OBJECTIVE
To investigate the presence and outcome of uterine vascular malformations in women with abnormal premenopausal bleeding.


METHODS
In this observational study 265 consecutive patients with abnormal premenopausal bleeding were examined by the same ultrasonographer with transvaginal gray-scale ultrasonography and color Doppler imaging. A final diagnosis of uterine vascular malformation was based on ultrasonographic findings, hysteroscopy or histological findings. Patients suspected of uterine vascular malformations at ultrasonography were closely monitored.


RESULTS
In nine patients (3.4%) we found ultrasonographic features of uterine vascular malformations. Color Doppler imaging showed hypervascularity, marked turbulence, and low-impedance, high-velocity flow. In six patients the condition resolved spontaneously. Two patients with hydatiform mole needed chemotherapy and their condition normalized. One patient underwent a selective embolization of the uterine artery. Subsequently, five patients had uncomplicated pregnancies after resolution of the vascular malformation.


CONCLUSIONS
Uterine vascular malformations are more common than previously thought. We conclude that conservative management is a valuable option in many of the acquired pregnancy-related cases that are diagnosed with color Doppler imaging.
Timmerman
D
D
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium. dirk.timmerman@uz.kuleuven.ac.be
Van den Bosch
T
T
Peeraer
K
K
Debrouwere
E
E
Van Schoubroeck
D
D
Stockx
L
L
Spitz
B
B
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014592:Uterine Hemorrhage / Q000209:etiology; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging