Uterine arteriovenous malformation after gestational trophoblastic disease - Revista Brasileira de Ginecologia e Obstetrícia

PURPOSE: to investigate the presence and outcome of uterinevascular malformations (UVAM) after gestational trophoblastic disease (GTD). METHODS: retrospective study of 2764 patients with GTD diagnosed from 1987 to 2004. All patients were followed up annually at the “Santa Casa da Misericórdia” Trophoblastic Disease Center (Rio de Janeiro, RJ, Brazil) with transvaginal ultrasonography (US) and color Doppler imaging. Seven patients had a final diagnosis of UVAM based on ultrasonographic analysis – pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) – and pelvic magnetic nuclear resonance (MNR) findings. Negative beta-hCG values were of utmost importance to establish differential diagnosis with persistent GTD. RESULTS: the incidence of UVAM after GTD was 0.2% (7/2764). US features of UVAM: PI mean 0.44±0,058 (extremes: 0.38-0.52); RI mean 0.36±0.072 (extremes: 0.29-0.50); PSV mean 64.6±23.99 cm/s (extremes: 37-96). MNR image showed a bulky uterus, myometrial inhomogeneity, serpiginous flow-related signal voids, and prominent parametrial vessels. The most common UVAM clinical presentation was vaginal hemorrhage, present in 52.7% (4/7). Pharmacological management with 150 mg medroxyprogesterone acetate was employed to control bleeding, after hemodynamic stabilization. These patients are still being followed and remain asymptomatic nowadays. Two patients with persistent UVAM became pregnant and had successful outcomes. CONCLUSION: patients with antecedent of GTD presenting transvaginal bleeding and negative beta-hCG may be considered to have UVAM and should be investigated through US with Doppler velocimetry. Conservative management is a valuable option in many of the acquired UVAM after GTD.