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Master Thesis

État des lieux de la prise en charge diagnostique et thérapeutique des lésions utérines hypervascularisées après terminaison de grossesse. Étude rétrospective au CHU de Montpellier entre septembre 2013 et octobre 2019

Abstract : With advances in Doppler ultrasound, more and more vascular uterine lesions are being diagnosed. It is important not to confuse with true arteriovenous malformations, which are treated differently. The main objective of our study was to describe and analyse our diagnostic and therapeutic practices. The secondary objectives were to analyse failures, to look for factors associated with haemorrhagic recurrence and failure in the case of non-invasive management, and to learn about patients' experiences. Methods: in this retrospective descriptive and comparative single-center study, all patients with a vascular uterine lesion defined as the presence on Doppler ultrasound of a focal or diffuse vascularized area in the endometrium and/or myometrium with or without retained products of conception (RPOC) were included. We described and analysed the different treatments according to urgency and invasiveness. The success rate was defined by uterine vacuity on ultrasound. Predictive risk factors of bleeding and failure were investigated if management was non-invasive. All patients were interviewed by phone about their experiences and subsequent fertility. Results: vascular uterine lesions were suspected in 224 patients, confirmed in 64 patients included in the analysis. We observe an evolution in practices with 72.4% of patients having a referring ultrasound and 70% to MRI for diagnostic confirmation. However, the classifications of vascularisation are not applied. Forty-five patients were managed in a non-invasive expectant (group 1, n=30) and medical (group 2, n=15), 3 patients were managed by hysteroscopy after preventive embolization (group 3) and 1 by hysteroscopy alone (group 4). The success rates were 47%, 27%, 33% and 0% respectively. The time to resolution of symptoms was 43 days in group 1. In the case of non-invasive management, in uni-varied analysis, the size of the vascular lesion on ultrasound was associated with haemorrhagic recurrence, which concerned 22% of patients (p=0.024). MRI criteria: presence of vascular lesion (p=0.011), interruption of the junction zone (p=0.015), presence of an arteriovenous shunting (p=0.039) were associated with failure. None of these criteria was significant in multivariate analysis. Expectant management alters the quality of life of patients for fear of haemorrhagic recurrence for 75% of patients concerned. Achieving pregnancy was possible regardless of the treatment group. Conclusion: in the absence of urgency, ultrasound criteria relevant to the clinical setting, patient choice, and in some cases requesting an MRI to optimize the management of hypervascularized RPOC should be used.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03153411
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Submitted on : Friday, February 26, 2021 - 12:30:51 PM
Last modification on : Monday, October 11, 2021 - 1:25:03 PM
Long-term archiving on: : Thursday, May 27, 2021 - 6:32:37 PM

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Sophie Gau. État des lieux de la prise en charge diagnostique et thérapeutique des lésions utérines hypervascularisées après terminaison de grossesse. Étude rétrospective au CHU de Montpellier entre septembre 2013 et octobre 2019. Médecine humaine et pathologie. 2020. ⟨dumas-03153411⟩

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