Ultrasonographic indications for conservative treatment in pregnancy-related uterine arteriovenous malformations

Abstract

Background: Uterine arteriovenous malformations (AVMs) are known to spontaneously regress. Purpose: To assess the predictive value of ultrasonography for patients requiring conservative treatment for pregnancy related to AVMs. Material and Methods: Our prospective study included 75 patients (conservative management:therapeutic management ¼45:30) with vaginal bleeding from pregnancy-related AVM. Clinical and ultrasonography examinations were reviewed, and the following information was gathered: complete blood count, AVM maximal diameter, AVM echogenicity, retained product of conception, number of blood vessels, and spectral Doppler (pulsatility index [PI], resistance index [RI], peak systolic velocity [PSV], time-averaged maximum velocity [TAMXV]). The Doppler criteria by Timmerman (mean PSV >70 cm/s: therapeutic management, mean PSV<52 cm/s: conservative management) were used for the initial management selection. The association between experimental variables and outcomes was assessed to determine their usefulness for predicting conservative management. Results: Features strongly associated with conservative management and their accuracy were PSV 89.6%, hemoglobin 84.7%, RI 83.1%, TAMXV 79.3%, and PI 78.6%. The overall accuracy for correct outcome classification was 64 (85.3%) of 75 patients. Most patients with conservative management had quicker improvement of symptoms and spontaneous regression at follow-up. Conclusion: Ultrasonography can accurately predict selection of conservative management. Keywords Arteriovenous malformations (AVMs), uterus, ultrasonography Date received: 10 June 2013; accepted: 4 November 2013