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Management of vascular uterine lesions associated with persistent low-level human chorionic gonadotrophin
  1. Kate L Darlow, MBChB, Specialist Registrar1,
  2. Andrew W Horne, PhD, MRCOG, Principal Lecturer2,
  3. Hilary O D Critchley, MD, FRCOG, Professor of Reproductive Medicine2,
  4. W Colin Duncan, MD, MRCOG, Consultant2 and
  5. Jane Walker, MBChB, FRCR, Consultant Radiologist3
  1. Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. Department of Reproductive and Developmental Sciences, University of Edinburgh, UK
  3. Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Kate Darlow, Department of Obstetrics and Gynaecology, St John's Hospital, Howden, Livingston, West Lothian EH54 6PP, UK. E-mail: katedarlow{at}doctors.org.uk

Abstract

Background and methodology Vascular lesions of the uterus are rare but pose difficult management decisions. We reviewed the cases of four patients who presented with vascular uterine lesions following early pregnancy loss at the Royal Infirmary of Edinburgh, Edinburgh, UK in 2006.

Results All four patients had signs on colour Doppler imaging consistent with arteriovenous malformations and elevated serum human chorionic gonadotrophin (hCG) levels. In each case, once the hCG level had returned to normal the uterine lesions resolved. The first case required therapeutic embolisation but the subsequent patients were successfully managed conservatively.

Conclusions Most uterine vascular lesions are attributed to arteriovenous malformations but those associated with pregnancy represent subinvolution of the placental bed and can be managed conservatively with monitoring of hCG concentrations.

  • embolisation
  • haemorrhage
  • human chorionic gonadotrophin (hCG)
  • miscarriage
  • vascular malformation

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