Abstract:

Pregnancy-associated enhanced myometrial vascularity (EMV) is a sonographic finding commonly observed in early pregnancy fetal demise or retained products of conception. It is characterized by abundant vascular signals within the myometrium that may extend to the serosal layer, and can be easily confused with uterine arteriovenous fistula or placental remnant. This article reports the clinical data of two patients with pregnancy-associated EMV. In case one, the patient presented with uterine retention following curettage. Ultrasound demonstrated heterogeneous echoes with rich blood flow signals in the right cornual and endometrial cavity. After treatment with mifepristone combined with gonadotropin-releasing hormone agonist, the blood flow was significantly reduced. Hysteroscopic removal of retained conception products was subsequently performed, And pathological examination confirmed retained products of conception. In case two, the patient experienced vaginal bleeding at 9 weeks of gestation. Ultrasound showed abundant blood flow in the posterior myometrial wall. Due to prominent symptoms, timely hysteroscopic removal of conception products and electric suction curettage were performed. Pathological findings confirmed embryonic demise with retained products. The diagnosis and management of pregnancy-associated EMV should be based on comprehensive assessment of medical history and hemodynamic status to avoid excessive intervention. For hemodynamically stable patients, delayed surgical intervention after medical therapy may be considered, whereas symptomatic patients should receive prompt surgical management to reduce risks and improve reproductive outcomes.

Key words: Enhanced myometrial vascularity, Retained products of conception, Fetal demise, Ultrasonography, Doppler, Hysteroscopy