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Ginecología y obstetricia de México

versión impresa ISSN 0300-9041


ALANIS-FUENTES, José  y  MUNOZ-ARTEAGA, Verónica. Arteriovenous malformation after retention of products of conception. Ginecol. obstet. Méx. [online]. 2022, vol.90, n.11, pp.886-892.  Epub 27-Ene-2023. ISSN 0300-9041.


To propose an effective, safe and outpatient procedure for patients with retained chorioplacental remnants and risk of arteriovenous fistula formation.


Retrospective case series study of patients attended at the Gea González Hospital from January to May 2022. A Bettocchi equipment was used, 5 mm continuous flow, 2.9 mm cylindrical lens and 30°. In specific cases a surgical procedure was scheduled with a Richard Wolf Princess resectoscope, 7 mm outer diameter, 2.7 mm optical system, 30° visual direction.


We reviewed 642 files from which we obtained a series of 31 cases that were included according to the Gutenberg classification, with biopsy by postabortion protocol and resection with Grasper for types 0 and 1; two patients were sent to the ER for heavy bleeding for immediate MVA; two patients were categorized as type 3; in the first one we opted for medical treatment with methotrexate with which we achieved complete resolution and the second one ended the pregnancy with laparoscopic hysterectomy.


In patients with ultrasound images suggestive of retained chorioplacental debris or arteriovenous malformation, direct vision procedures avoid immediate and future complications. Diagnosis by Gutenberg classification allows to define the type of access with cold extraction with Grasper forceps for types 0 and 1, or the application of a pharmacological test with methotrexate and hysteroscopic resection for types 2 and 3 in hemodynamically stable patients.

Palabras llave : Arteriovenous malformation; Methotrexate; Hysteroscopy; Gutenberg Classification; Retained products of conception.

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