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About uterine enhanced myometrial vascularity: Doppler ultrasound could reduce misdiagnosed life-threatening vaginal bleeding after pregnancy and guide the management

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Abstract

Enhanced myometrial vascularity is a rare entity in which an abnormal communication between vessels of the myometrial wall, potentially derived from all pregnancies, increases bleeding risk. Spontaneous regression is possible, but often, it is not foreseeable in which cases it’s better to adopt a waiting behaviour and in which others a treatment is required. We reported three cases of enhanced myometrial vascularity: two occurring after vaginal delivery, and the third one after a scar pregnancy. The first case was successfully treated by embolization, the second one was subjected to curettage complicated by uterine perforation; the third one underwent embolization as well, but subsequently required hysterctomy for persistent methrorragia. As we treated these similar cases in three different ways, we decided to perform a mini review of the literature in the aftermath. Considering literature data, we strongly believe that the detection of peak systolic speed by colour-Doppler ultrasound together with a careful evaluation of clinical symptoms, could be a good guide to the best treatment of each patient.

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Acknowledgements

The authors thanks Nina Pinna, MD, for the support in manuscript revision.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy

    Paola Algeri

  2. Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy

    Maria Donata Spazzini, Stefano Garbo & Antonella Villa

  3. Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza e Brianza, Italy

    Marta Seca

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  1. Paola Algeri
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  2. Maria Donata Spazzini
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  3. Marta Seca
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  4. Stefano Garbo
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  5. Antonella Villa
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Contributions

All authors contributed to the study. Material preparation, data collection were performed by MDS and AV. The first draft of the manuscript was written by PA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Paola Algeri.

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Algeri, P., Spazzini, M.D., Seca, M. et al. About uterine enhanced myometrial vascularity: Doppler ultrasound could reduce misdiagnosed life-threatening vaginal bleeding after pregnancy and guide the management. J Ultrasound 26, 695–701 (2023). https://doi.org/10.1007/s40477-022-00734-8

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  • DOI: https://doi.org/10.1007/s40477-022-00734-8

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