Spontaneous Regression of Uterine Arteriovenous Malformations with Conservative Management

Abstract

Uterine arteriovenous malformation (AVM) can cause massive hemorrhage and is often treated with uterine artery embolization (UAE), which may lead to ovarian insufficiency. Thus, avoiding UAE should be considered, particularly in women undergoing fertility treatments. We present three women diagnosed with postmiscarriage AVM on color Doppler by transvaginal ultrasound imaging. They had no genital bleeding and a small mass, measuring 16-22 mm. If estradiol was >300 pg/mL when AVM was diagnosed, then a gonadotropin-releasing hormone agonist was administered. All three women underwent follow-up observation, revealing spontaneous mass disappearance. To avoid ovarian insufficiency risk with UAE, conservative management and close follow-up observation should be considered in patients with AVM without bleeding, particularly during the fertility treatment.

Figure 1

Diagnosis of AVM by Doppler examination (Patient 1). (a) Several arteries were observed in AVM. (b) A turbulent aspect in the fistula. (c) Venous flow in the intramural venous plexus.

Figure 2

AVM depicted by ultrasonography using grayscale and color Doppler (Patient 1, mass measuring 22 × 19 mm in size).

Figure 3

AVM spontaneously regressed after 6 weeks without UAE (Patient 1).

Figure 4

AVM depicted by ultrasonography using grayscale and color Doppler (Patient 2, mass measuring 16 × 6 mm in size).

Figure 5

AVM depicted by ultrasonography using grayscale and color Doppler (Patient 3, mass measuring 20 × 15 mm in size).