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Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review

  • General Gynecology
  • Published:
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Abstract

Purpose

To perform an extensive systematic review to examine all the available literature reporting iatrogenic acquired arteriovenous malformation (AVM) induced after diagnostic curettage and to describe a further case of a 34-year-old woman presenting with acute vaginal bleeding due to AVM induced after uterine curettage for termination of pregnancy.

Methods

We searched the electronic databases: MEDLINE (1950–2011), Embase (1980–2011), Cochrane Library (2004–2011), Cinahl (1981–2011), Popline (2004–2011).

Results

Initial search extracted 333 relevant articles. Final assessment resulted to the inclusion of 91 studies, 85 case reports and 6 observational studies. Studies are dated between 1954 and 2011. A metanalysis of the 85 case reports reporting 100 patients was performed. The mean age of the women diagnosed with AVM was 30 ± 9.1 years, range (16–72) years, 96 women were premenopausal (96%) and 4 were postmenopausal (4%). Ultrasound imaging was applied in 86 patients (86%), and ultrasound combined with angiography was performed in 51 patients (51%). Uterine artery embolization (UAE) was the most common treatment option performed in 59 patients (59%). Total abdominal hysterectomy was performed in 29 patients (29%). Spontaneous resolution of AVM occurred in six patients (6%). In 17 patients (17%), recurrence occurred after treatment with UAE. Twenty-four articles reported pregnancies in 27 patients (27%).

Conclusion

Ultrasound imaging with appropriate knowledge of color Doppler features minimizes the use of inappropriate interventional procedures such as diagnostic curettage. UAE is effective in treatment, and rarely leads to complications.

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Acknowledgments

We would like to thank the Radiology department of Royal Free Hospital for their collaboration.

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The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Royal Free Hospital, University College Pond Street, NW3 2Q, London, UK

    Panagiotis Peitsidis

  2. Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany

    Rolf Kreienberg & Lukas Schwentner

  3. Bioiatriki laboratories, Athens, Greece

    Emmanouil Manolakos

  4. Department of Anesthesiology, Alexandra Hospital, Athens, Greece

    Vasiliki Tsekoura

  5. Helena Venizelou Hospital, Proussis 22, P.C 17123, Athens, Greece

    Panagiotis Peitsidis

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Peitsidis, P., Manolakos, E., Tsekoura, V. et al. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet 284, 1137–1151 (2011). https://doi.org/10.1007/s00404-011-2067-7

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