Ультразвуковая диагностика усиленной васкуляризации миометрия после прерывания беременности: обзор литературы и разбор клинического наблюдения

Внедрение допплерографии в клиническую практику позволило наблюдать изменения сосудистой сети матки после завершения беременности. Феномен усиленной васкуляризации миометрия (УВМ) указывает на замедленное восстановление параметров кровотока, часто ассоциирован с задержкой продуктов зачатия в полости матки (retained products of conception – RPOC), но имеет сходные акустические характеристики с артериовенозной мальформацией матки.

Актуальна дифференциальная диагностика сосудистых аномалий с RPOC, поскольку, с одной стороны, это может вести к избыточному лечению, с другой стороны – к ятрогенному профузному кровотечению в случае попытки хирургической эвакуации содержимого полости матки при нераспознанной сосудистой аномалии.

Хотя ангиография является “золотым стандартом” диагностики, многие специалисты в последние два десятилетия для выявления УВМ предпочитают допплерографию ввиду неинвазивности и полезности для определения тактики лечения, включая необходимость применения эмболизации маточных артерий. К настоящему времени дифференциальная диагностика физиологических и патологических особенностей миометрального кровотока не разработана, не выделены маркеры, указывающие на вероятность спонтанного регресса либо персистенции УВМ с риском профузного кровотечения. Клиническое значение феномена УВМ у асимптомных пациенток также неясно.

Картирование зоны сосудистой аномалии с использованием допплерографии позволяет четко определить распространенность процесса и предупредить осложнения при выборе оптимального метода хирургического вмешательства.

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