UTERINE ARTERIOVENOUS MALFORMATION: A CLINICAL CASE

Objective. To analyze a case of uterine arteriovenous malformation, a rare abnormality of small pelvic organs, in a 29-year-oldprimiparous multigravida at 23-24 weeks’ gestation. Subjects and methods. A 29-year-old primiparous multigravida at 2324 weeks’ gestation diagnosed with cervical varices was examined at the Department of Ultrasound Diagnosis, Chelyabinsk Regional Perinatal Center. Ultrasonography was performed using a Voluson E6 apparatus (General Electric, USA) having transabdominal and transvaginal transducers with color Doppler flow mapping and pulsed wave Doppler. Results. Ultrasonography showed that the fetal size corresponded to a gestational age of 23-24 weeks; no fetal anomalies were detected; the placenta was located at the anterior uterine wall, failed to block the internal uterine mouth area, it was thickened up to 52 mm; there was expansion of intervillous spaces with slow blood circulation and subamniotic cysts of up to 37 mm, oligohydramnios, and small pelvic varices. The anterior wall of the uterus mainly in its lower third displayed myometrial varices of up to 10-12 mm and a cystic structural focus of up to 28 mm; local hypervascularization with mosaic staining; the parametrial veins were dilated up to 17 mm. The uterine cervix was enlarged, 94 x 90 x 95 mm in size, had a barrel-like shape with well-defined even contours, a heterogeneous wide-meshed structure with multiple anechogenic inclusions. Conclusion. Objectively, there were vascular changes: uniform cervical hypervascularization with the mosaic staining characteristic of turbulent blood flow. Pulsed wave Doppler revealed a high hyporesistant vascular blood flow velocity of up to 25-40 cm/sec, wh ich depended on the diameter of vessels; the resistance index was 0.42.

uterine arteriovenous malformation, bleeding, ultrasound study, color Doppler flow mapping