Uterine Arteriovenous Malformation / Enhanced Myometrial Vascularity (EMV)

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Myometrial vessels · PSV stratification
   Honeycomb myometrial vessels — PSV stratification and bleeding? (Uterine AVM/EMV = honeycomb tortuous myometrial vessels + arteriovenous shunting, usually acquired (after D&C/instrumentation/miscarriage/cesarean/CSP). US: grayscale irregular anechoic tubular myometrial channels; color Doppler lights up with high-velocity turbulence, spectral multidirectional high-velocity low-resistance; higher PSV means greater bleeding risk. Key contraindication: no blind curettage/biopsy → massive bleeding.)
   • Active heavy bleeding or high PSV → High PSV/heavy bleeding · UAE
   • Low PSV, mild bleeding/hemodynamically stable → Low PSV · expectant + serial ultrasound
2. [End] Low PSV · expectant + serial ultrasound
   Low PSV, mild bleeding/hemodynamically stable: expectant + serial ultrasound follow-up (acquired EMV often regresses spontaneously); avoid intrauterine instrumentation; track beta-hCG to exclude retained trophoblast; escalate if bleeding worsens or PSV rises.
3. [End] High PSV/heavy bleeding · UAE
   Active heavy bleeding or high PSV: no curettage/biopsy; uterine artery embolization (UAE) is the first-line definitive treatment; hemodynamic resuscitation; hysterectomy as a last resort for refractory/life-threatening cases; UAE preferred for those wanting fertility.

Source guidelines & references

• Acquired uterine EMV/AVM ultrasound diagnosis and management (AJOG; UOG 2018) · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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