Uterine AV malformation TOG 2015

Question 1

When to AV malformation commonly present? How does it present?

Answer 1

Postpartum periods or a few mothers after spont miscarriage, ERPC, TOP

Unexplained, intermittent, heavy vaginal bleeding

negative PT

Question 2

Which type of pregnancy is most likely to lead to AV malformation?

Answer 2

Complete molar pregnancy

Question 3

How does an AV malformation appear on USS?

Answer 3

Multiple anechoic spaces

Question 4

How does AV malformation appear on USS with colour doppler?

What does spectral doppler analysis show?

Answer 4

Increased vascularity within myometrium, low impedance, high velocity

Spectral doppler shows high peak velocity with low resistance

Question 5

What is the gold standard for diagnosis of AVM

Answer 5

Subtraction pelvic angiography, consider treatment at the same time to avoid repeating the procure

Question 6

What factors does the management of AVM depend on

Answer 6

haemodynamic status
size and site of the lesion
degree of bleeding
age
desire for future fertility.

Question 7

If AVM secondary to gestational trophoblastic disease and clinical stable what treatment

Answer 7

Offer chemotherapy as majority will resolve with this alone

Question 8

Most common treatment for AV malformation

Answer 8

UA embolisation

Question 9

Managemention options

Answer 9

Monitoring
Medical treatments - COCP, danazol, medroxyprogesteorne

Embolisation
Surgical - ligation of uterine artery or hysterectomy

Question 10

Does uterine artery embolisation impact mensus or fertility?

Answer 10

Normal menses
Preservation of fertility
Uneventful pregnancy (no known increased SGR, adherent placenta)