{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T11:11:37Z","timestamp":1772017897245,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Uterine arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) are rare but potentially life-threatening vascular anomalies that most commonly develop after pregnancy-related uterine trauma, such as curettage or surgical evacuation. The widespread use of color Doppler ultrasonography has led to increased recognition of these lesions and a shift from hysterectomy toward fertility-preserving, minimally invasive management. This narrative review summarizes current evidence on acquired uterine AVF\/AVM after early pregnancy loss, with particular emphasis on diagnostic challenges and contemporary therapeutic approaches, illustrated by representative clinical experience. Materials and Methods: A narrative review of the literature was conducted focusing on the pathophysiology, ultrasound and Doppler diagnostic criteria, interventional radiologic techniques, hysteroscopic management, and fertility outcomes in acquired uterine AVF\/AVM. Illustrative clinical insights from anonymized post-abortion cases managed at our institution were incorporated solely to contextualize diagnostic and therapeutic considerations. Results: Color and spectral Doppler ultrasonography emerged as the diagnostic cornerstone, typically demonstrating serpiginous myometrial vessels with high-velocity, low-resistance turbulent flow, allowing for differentiation from retained products of conception. Uterine artery embolization showed high efficacy in achieving hemorrhage control, while hysteroscopic coagulation or resection represented an effective complementary or, in selected focal lesions, definitive treatment. Clinical experience highlighted that AVF-related vascularity may be evident early or may evolve over time, underscoring the importance of repeat Doppler evaluation in patients with persistent or recurrent bleeding. Conclusions: Acquired uterine AVF should be considered in women presenting with ongoing or recurrent uterine bleeding following aspiration abortion or curettage, even when initial Doppler findings are inconclusive. Individualized, minimally invasive strategies\u2014often combining uterine artery embolization and hysteroscopic techniques\u2014offer effective, uterus-preserving alternatives to hysterectomy.<\/jats:p>","DOI":"10.3390\/medicina62020422","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T16:22:55Z","timestamp":1771863775000},"page":"422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acquired Uterine Arteriovenous Fistulas After First-Trimester Pregnancy Loss: A Narrative Review with Case-Based Insights into Minimally Invasive Management"],"prefix":"10.3390","volume":"62","author":[{"given":"R\u0103zvan-Grigora\u0219","family":"C\u0103pit\u0103nescu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena-Iuliana-Anamaria","family":"Berbecaru","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3631-9107","authenticated-orcid":false,"given":"Anca-Maria","family":"Istrate-Ofi\u021beru","sequence":"additional","affiliation":[{"name":"Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian-Valentin","family":"Zoril\u0103","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doru-Andrei","family":"Mitroi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriela-Camelia","family":"Ro\u0219u","sequence":"additional","affiliation":[{"name":"Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7823-3387","authenticated-orcid":false,"given":"Dominic-Gabriel","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana-Cristina","family":"Dr\u0103gu\u0219in","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0534","authenticated-orcid":false,"given":"Lauren\u021biu-Mihai","family":"D\u00eer\u0103","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria-Cristina","family":"Com\u0103nescu","sequence":"additional","affiliation":[{"name":"Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George-Lucian","family":"Zoril\u0103","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emergency County Hospital of Craiova, 200642 Craiova, Romania"},{"name":"Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1055\/s-0035-1563721","article-title":"A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology, Diagnosis, and Transcatheter Treatment","volume":"6","author":"Yoon","year":"2016","journal-title":"AJP Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1097\/01.ogx.0000183684.67656.ba","article-title":"Uterine Arteriovenous Malformations: A Review of the Current Literature","volume":"60","author":"Grivell","year":"2005","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s00404-011-2067-7","article-title":"Uterine Arteriovenous Malformations Induced after Diagnostic Curettage: A Systematic Review","volume":"284","author":"Peitsidis","year":"2011","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_4","first-page":"1387\u20131392; quiz 1394\u20131395","article-title":"Uterine Arteriovenous Malformations: From Diagnosis to Treatment","volume":"25","author":"Neyastani","year":"2006","journal-title":"J. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1097\/01.RVI.0000096761.74047.7D","article-title":"Efficacy of Embolization in Traumatic Uterine Vascular Malformations","volume":"14","author":"Ghai","year":"2003","journal-title":"J. Vasc. Interv. Radiol. JVIR"},{"key":"ref_6","first-page":"1","article-title":"Standardizing the Classification of Abortion Incidents: The Procedural Abortion Incident Reporting and Surveillance (PAIRS) Framework","volume":"96","author":"Taylor","year":"2017","journal-title":"Contraception"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.contraception.2015.07.013","article-title":"Complications from First-Trimester Aspiration Abortion: A Systematic Review of the Literature","volume":"92","author":"White","year":"2015","journal-title":"Contraception"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1093\/humrep\/dev097","article-title":"Uterine Artery Embolization for Uterine Arteriovenous Malformation in Five Women Desiring Fertility: Pregnancy Outcomes","volume":"30","author":"Vilos","year":"2015","journal-title":"Hum. Reprod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E92","DOI":"10.1055\/s-0031-1273274","article-title":"Pregnancy-Related Uterine Arteriovenous Malformations: Experience from a Single Medical Center","volume":"32","author":"Vaknin","year":"2011","journal-title":"Ultraschall Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3109\/00016348209156958","article-title":"Conservative Treatment of Uterine Arteriovenous Fistula","volume":"61","author":"Forssman","year":"1982","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.crad.2011.11.002","article-title":"Efficacy and Safety of Embolization in Iatrogenic Traumatic Uterine Vascular Malformations","volume":"67","author":"Wang","year":"2012","journal-title":"Clin. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"367","DOI":"10.3349\/ymj.2014.55.2.367","article-title":"Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization","volume":"55","author":"Kim","year":"2014","journal-title":"Yonsei Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/S0015-0282(01)02900-4","article-title":"Successful Treatment of Symptomatic Arteriovenous Malformation of the Uterus Using Laparoscopic Bipolar Coagulation of Uterine Vessels","volume":"76","author":"Wu","year":"2001","journal-title":"Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1136\/ijgc-00009577-200705000-00028","article-title":"Uterine Arteriovenous Malformation: Fertility-Sparing Surgery Using Unilateral Ligation of Uterine Artery and Ovarian Ligament","volume":"17","author":"Milingos","year":"2007","journal-title":"Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.jmig.2014.07.016","article-title":"Fertility-Preserving Management of a Uterine Arteriovenous Malformation: A Case Report of Uterine Artery Embolization (UAE) Followed by Laparoscopic Resection","volume":"22","author":"Patton","year":"2015","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2016.00109","DOI":"10.4293\/JSLS.2016.00109","article-title":"Hysteroscopic Management of Uterine Arteriovenous Malformation","volume":"21","author":"Calzolari","year":"2017","journal-title":"JSLS"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Huang, L., Qiu, L., Zhang, J., Ye, H., and Xiong, X. (2025). Medical Treatment of Acquired Uterine Arteriovenous Fistulae Related to Pregnancy: 2 Case Reports and Literature Review. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1584099"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.fertnstert.2005.06.058","article-title":"Pregnancy after Embolization Therapy for Uterine Arteriovenous Malformation","volume":"85","author":"Delotte","year":"2006","journal-title":"Fertil. Steril."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5387\/fms.2013-13","article-title":"Uterine Artery Embolization for Uterine Arteriovenous Malformation Is Associated with Placental Abnormalities in the Subsequent Pregnancy: Two Cases Report","volume":"60","author":"Soeda","year":"2014","journal-title":"Fukushima J. Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"167","DOI":"10.31083\/j.ceog5008167","article-title":"Ultrasound Diagnosis of Uterine Arteriovenous Malformations: A Systematic Review","volume":"50","author":"Borrero","year":"2023","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ruiz Labarta, F.J., Pintado Recarte, M.P., Gonz\u00e1lez Leyte, M., Arribas, C.B., \u00c1lvarez Luque, A., Cu\u00f1arro L\u00f3pez, Y., Garc\u00eda-Montero, C., Fraile-Martinez, O., Ortega, M.A., and De Le\u00f3n-Luis, J.A. (2022). Uterine Artery Embolization of Uterine Arteriovenous Malformation: A Systematic Review of Success Rate, Complications, and Posterior Pregnancy Outcomes. J. Pers. Med., 12.","DOI":"10.3390\/jpm12071098"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00270-022-03105-2","article-title":"Fertility Outcomes After Uterine Artery Embolization for Symptomatic Uterine Arteriovenous Malformations: A Single-Center Retrospective Study in 33 Women","volume":"45","author":"Ghanaati","year":"2022","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.fertnstert.2021.05.095","article-title":"Medical Treatment of Uterine Arteriovenous Malformation: A Systematic Review and Meta-Analysis","volume":"116","author":"Rosen","year":"2021","journal-title":"Fertil. Steril."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T10:18:57Z","timestamp":1772014737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020422"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020422","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]}}}