Ultrasound in Obstetrics and Gynecology
Ultrasound in Obstetrics and Gynecology
5 years ago

Diagnosis and Management of Patients with Enhanced Myometrial Vascularity Associated with Retained Products of Conception

Beryl R. Benacerraf, Amie Lynn Healy Murphy, Yvette S. Groszmann
Objectives We performed this study to assess the complication rate, including the estimated amount of blood loss, in patients who underwent dilation and curettage for treatment of retained products of conception with markedly enhanced myometrial vascularity mimicking arteriovenous malformations. Methods This is a retrospective medical records review study of patients with retained products of conception with enhanced myometrial vascularity presenting to our ultrasound unit between August 1, 2015 and August 1, 2017. Color Doppler imaging was used subjectively to identify the degree and extent of vascularity. All patients underwent dilation and curettage and the operative reports and medical records reviewed to identify if ultrasound guidance was used, the estimated blood loss and complications during or after the procedure. Results The study group included 31 patients. 7/31 had retained products of conception after a vaginal delivery and 24/31 after a first trimester spontaneous or induced abortion. The largest dimension of the region of enhanced myometrial vascularity ranged from 10 mm to 53 mm with 15/31 having a width ≥ 20 mm. 15/31 had a standard dilation and curettage procedure, 13/31 had an ultrasound guided procedure and 3/31 were performed with hysteroscopy. Estimated operative blood loss varied from a report of “minimal” to a maximum of 400 cc. There were no intraoperative complications, 1/31 patients was treated for endometritis. Conclusion An increasing number of studies describe the enhanced myometrial vascularity associated with retained products of conception as “acquired arteriovenous malformations” with some recommending management with uterine artery embolization. Our study demonstrates that the enhanced myometrial vascularity is associated with retained products of conception and surgical removal by D&C, possibly with the aid of ultrasound guidance or hysteroscopy, is safe.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18954

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