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Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence!

ABSTRACT: A 23-year-old lady presented with a 10-month history of multiple episodes of prolonged and erratic menstrual bleeding having undergone a surgical termination of pregnancy. Initially, pelvic ultrasound and hysteroscopy were found to be normal and for many months she was treated pharmacologically for dysfunctional uterine bleeding. She also tried both a copper-coil and MIRENA intrauterine system, which were both expelled due to heavy bleeding characterised by 'a clot the size of two fists'. She required blood transfusions on multiple admissions, was forced to resign from her job and later became depressed. Under our care a transvaginal ultrasound scan showed a hypervascular region on the posterior uterine wall. An urgent hysteroscopy was performed due to her haemoglobin being 5.7 g/dl and revealed a pulsating lesion abutting the endometrium, which can be seen here on video. MR angiography confirmed an arteriovenous malformation and she was successfully treated with uterine artery embolisation.

SUBMITTER: Clarke JA

PROVIDER: S-EPMC4543807 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence!

Clarke Joseph Adam JA Viswanatha Radhika Kashi RK Hamid Rosol R Sankaranarayanan Subha S

BMJ case reports 20121204

A 23-year-old lady presented with a 10-month history of multiple episodes of prolonged and erratic menstrual bleeding having undergone a surgical termination of pregnancy. Initially, pelvic ultrasound and hysteroscopy were found to be normal and for many months she was treated pharmacologically for dysfunctional uterine bleeding. She also tried both a copper-coil and MIRENA intrauterine system, which were both expelled due to heavy bleeding characterised by 'a clot the size of two fists'. She re ...[more]

PMID: 23213129

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Project description:BACKGROUND:Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation is an endovascular intervention based on the occlusion of the feeding arteries the pulmonary arteriovenous malformations thus eliminating the abnormal right-to-left-shunting. This is an update of a previously published review. OBJECTIVES:To determine the efficacy and safety of embolisation in patients with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices. SEARCH METHODS:We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register; date of last search: 10 April 2017.We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 27 August 2017). to be updatedWe checked cross-references and searched references from review articles. SELECTION CRITERIA:Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation compared to no treatment, surgical resection or embolisation using a different embolisation device. DATA COLLECTION AND ANALYSIS:Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. No trials were identified for inclusion in the review and hence no analysis was performed. MAIN RESULTS:There were no randomised controlled trials included in the review; one ongoing trial has been identified which may be eligible for inclusion in the future. AUTHORS' CONCLUSIONS:There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation is a safe procedure which reduces morbidity and mortality. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials.

Dataset Information

Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence!

Publications

Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence!

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