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Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management
D Timmerman1, T Van den Bosch, K Peeraer
1Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium. dirk.timmerman@uz.kuleuven.ac.be
Objective:
To investigate the presence and outcome of uterine vascular malformations in women with abnormal premenopausal bleeding.
Study Design:
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.
Conclusion:
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.