A Retrospective Study On Clinical Management Data Of 80 Cases With Pregnancy-Related Uterine Arteriovenous Malformation

Background:Uterine arteriovenous malformation is one kind of abnormal arteriovenous connections occurring in the uterus,sometimes causing irregular uterine bleeding and even can provoke massive life-threatening uterine hemorrhaging.There is no clear consensus on the current treatment of pregnancy-related uterine arteriovenous malformation,for which the conservative management performed an unsatisfactory rate of success and the indication or outcome of embolization treatment is not clinically clear.The current medical and surgical options are based on clinicians’experience and published case reports.Therefore,we should not only avoid the fertility and economic burden brought by over-diagnosis and treatment to patients,but also mitigate the threat of potential sudden bleeding to patients’life safety.Objective:To analysis the effectiveness of different treatments and to guide the clinicians a further understanding of the disease,thus help them identify pregnancy-related uterine arteriovenous malformation and give the appropriate treatment in time.Methods:Clinical data of 80 patients with pregnancy-related uterine arteriovenous malformation in Qilu Hospital of Shandong University from November 2011 to December 2018 were analyzed retrospectively,including clinical management,features of disease developing,therapy regimens,restoration and changes of menstruation,hospitalization stays and expenses relapse.Results:1.Among the 80 patients with pregnancy-related uterine arteriovenous malformation reviewed in our study,the median age is 3 lyears old with average in 1.2 births.All of them had a history of pregnancy or surgery,72.5%patients had accepted cesarean section at less once,43.8%patients had other uterine cavity operation treatments,such as induced abortion or dilation and curettage.2.All patients occurred complicating or secondary to pregnancy-related diseases.41 patients(51.3%)suffered from cesarean section pregnancy at the same time,33 patients(41.2%)got the uterine arteriovenous malformation after miscarriage,delivery,uterine surgery or dilation and curettage,6 patients(7.5%)have got gestational trophoblastic disease.3.There was no statistical difference(P>0.05)on the basic characteristics of patients(age,pregnancy,birth,abortion,cesarean section)between the surgery treatment group and medicine treatment group,as well as the surgery treatment group and medicine + surgery treatment group.There was a significant statistical difference(P<0.001)on the hospitalization stays,and there was no significant statistical difference(P=0.134)on the hospitalization pays between the surgery treatment group and medicine treatment group.And there was a significant statistical difference(P<0.001)on the hospitalization stays between surgery treatment group and medicine + surgery treatment group.,and no significant statistical difference on the hospitalization pays,intraoperative blood loss and intraoperative time.4.All of the patients in the surgical group resumed menstruation after treatment,6 patients(6/47)showed decreased menstrual volume,1 patient(1/47)suffered a relapse of uterine arteriovenous malformation,and 6 patients(6/10)with fertility requirements were pregnant again.7 patients(7/7)in the medicine group resumed menstruation after treatment.21 patients(21/22)in the medicine + surgery treatment group resumed menstruation,including 1 patient(1/22)who had no menstruation until the follow-up,2 patients(2/22)who had a menstrual quantity decrease,7 patients(7/8)with fertility requirements were pregnant again.Conclusion:Pregnancy-related uterine arteriovenous malformation always occurred in women of childbearing age.cesarean section pregnancy,gestational trophoblastic disease,miscarriage,delivery,uterine surgery or dilation and curettage are high risk factors to the occurrence of pregnancy-related uterine arteriovenous malformation.There is no clear consensus on the current treatment of uterine arteriovenous malformation,but our study suggests that medicine treatment in the early management of the cases of pregnancy-related uterine arteriovenous malformation have no significant in increasing patients’ benefits.Based on the evaluation of clinical symptoms,appropriate surgical treatment was selected as the first choice.