Malformacion uterina arteriovenosa / Uterine arteriovenous malformation

RESUMEN La malformación arteriovenosa uterina (MAVU) es una causa poco frecuente de sangrado uterino, dado que en la mayoría de casos cursa de forma asintomática. Las MAVU son dilataciones varicosas arteriovenosas intramiometriales sin afectación capilar. Plantean un reto diagnóstico y terapéutico en el esfuerzo de la preservación de la fertilidad, constituyéndose la embolización como su principal tratamiento. En la actualidad, el estándar de oro para el diagnóstico de esta patología es la angiografía. Sin embargo, las modalidades menos invasivas como la ecografía Doppler color se utilizan cada vez más para el diagnóstico. Se presenta el caso de una mujer de 20 años de edad, con antecedente de embarazo molar y sangrado menstrual excesivo debido a MAVU.

ABSTRACT Uterine arteriovenous malformation (AVMV) is a rare cause of uterine bleeding, since most cases are asymptomatic. The MAVU are intramyometrial arteriovenous variceal dilatations without capillary involvement. They propouse a diagnostic and therapeutic challenge in the effort for preservation of fertility, constituting the embolization its main treatment. At present, the gold standard for the diagnosis of this pathology is angiography. However, less invasive modalities such as color Doppler ultrasound are increasingly used for diagnosis. We present the case of a 20-year-old woman with a history of molar pregnancy and excessive menstrual bleeding due to MAVU.

Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial

Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation. The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension. A double-blind, placebo-controlled randomized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo, SP, Brazil. A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20-27 weeks gestation were randomly assigned to receive placebo (N = 26) or 100 mg aspirin plus 2 g calcium (N = 23) daily until delivery. The main outcome of this pilot study was development of superimposed preeclampsia. Secondary outcomes were fetal growth restriction and preterm birth. The rate of superimposed preeclampsia was 28.6% lower among women receiving aspirin plus calcium than in the placebo group (52.2 vs 73.1%, respectively, P=0.112). The rate of fetal growth restriction was reduced by 80.8% in the supplemented group (25 vs 4.8% in the placebo vs supplemented groups, respectively; P=0.073). The rate of preterm birth was 33.3% in both groups. The combined supplementation of aspirin and calcium starting at 20-27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler.