title: Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review.
abstract: OBJECTIVE
  To perform an extensive systematic review to examine all the available literature reporting iatrogenic acquired arteriovenous malformation (AVM) induced after diagnostic curettage and to describe a further case of a 34-year-old woman presenting with acute vaginal bleeding due to AVM induced after uterine curettage for termination of pregnancy.
  
  
  METHODS
  We searched the electronic databases: MEDLINE (1950-2011), Embase (1980-2011), Cochrane Library (2004-2011), Cinahl (1981-2011), Popline (2004-2011).
  
  
  RESULTS
  Initial search extracted 333 relevant articles. Final assessment resulted to the inclusion of 91 studies, 85 case reports and 6 observational studies. Studies are dated between 1954 and 2011. A metanalysis of the 85 case reports reporting 100 patients was performed. The mean age of the women diagnosed with AVM was 30 ± 9.1 years, range (16-72) years, 96 women were premenopausal (96%) and 4 were postmenopausal (4%). Ultrasound imaging was applied in 86 patients (86%), and ultrasound combined with angiography was performed in 51 patients (51%). Uterine artery embolization (UAE) was the most common treatment option performed in 59 patients (59%). Total abdominal hysterectomy was performed in 29 patients (29%). Spontaneous resolution of AVM occurred in six patients (6%). In 17 patients (17%), recurrence occurred after treatment with UAE. Twenty-four articles reported pregnancies in 27 patients (27%).
  
  
  CONCLUSIONS
  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.
authors: Department of Obstetrics and Gynaecology, Royal Free Hospital, University College Pond Street, NW3 2Q London, UK. peitsidi@ath.forthnet.gr
authors: Panagiotis
authors: P
authors: Peitsidis
authors: Emmanouil
authors: E
authors: Manolakos
authors: Vasiliki
authors: V
authors: Tsekoura
authors: Rolf
authors: R
authors: Kreienberg
authors: Lukas
authors: L
authors: Schwentner
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy; D001803:Blood Transfusion; D003475:Curettage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D055357:Uterine Artery Embolization / Q000379:methods; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D014599:Uterus / Q000098:blood supply; D055815:Young Adult