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Review
. 2024 Aug 27;13(4):209-214.
doi: 10.4103/gmit.gmit_29_24. eCollection 2024 Oct-Dec.

Role of Hysteroscopy in the Management of Uterine Vascular Malformations with a Focus on Enhanced Myometrial Vascularity - A Review of Diagnosis and Treatment with the Suggested Algorithm

Mohamed Siraj Shahulhameed  1 , Bernard Su Min Chern  1 , Ann M Wright  2
Affiliations
Review

Role of Hysteroscopy in the Management of Uterine Vascular Malformations with a Focus on Enhanced Myometrial Vascularity - A Review of Diagnosis and Treatment with the Suggested Algorithm

Mohamed Siraj Shahulhameed et al. Gynecol Minim Invasive Ther. .

Abstract

Postpregnancy bleeding is common after failed pregnancy, termination of pregnancy, and postnatally after both vaginal and cesarean delivery. Pelvic ultrasound (US) is usually the initial imaging modality of choice to ascertain the cause when the bleeding is heavy or prolonged. When used in combination with Doppler studies, US can help differentiate retained products of conception (RPOC) from rarer uterine vascular malformations (UVM), including true arterial vascular malformations and areas of enhanced endometrial vascularity (EMV), which may themselves be associated with any RPOC present. While the management of RPOC is well established and has evolved from an almost universal surgical approach to increasingly more medical or expectant alternatives, clinical decisions over the management of a concurrent UVM are less clear and treatment options need to be individualized depending on features of the lesion and the clinical situation with hysteroscopy featured as an important modality, especially when dealing with EMV's. In this review, we discuss the role of hysteroscopy in the treatment of enhanced myometrial vascularity with and without associated RPOC and propose a management algorithm.

Keywords: Enhanced myometrial vascularity; hysteroscopy; uterine arteriovenous malformation.

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Conflict of interest statement

Dr. Bernard Su Min Chern, an editorial board member at Gynecology and Minimally Invasive Therapy, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
Ultrasound images of enhanced myometrial vascularity. (a) Tubular anechoic serpentine structures with increased myometrial thickening and heterogeneity, enlarged vessels in the myometrial wall or parametrium, and a myometrial or endometrial mass, (b and c) Color and power Doppler studies show a turbulent high-velocity multidirectional low-resistance vascular network with aliasing and peak systolic velocity
Figure 2
Figure 2
Hysteroscopic pre- and postappearance of the uterine cavity. (a-e) Hysteroscopic appearance of enhanced myometrial vascularity with retained products of conception, (f) Appearance of the uterine cavity after hysteroscopic treatment enhanced myometrial vascularity
Figure 3
Figure 3
Algorithm for management – Enhanced myometrial vascularity. PSV: Peak systolic velocity, UAE: Uterine artery embolization
See this image and copyright information in PMC

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