Endometrial Vs Myometrial Vascular Lesions in Post-Pregnancy Bleeding: A Prospective Ultrasound and Color Doppler Study

Abstract

Background: Post-pregnancy bleeding is a common yet potentially life-threatening clinical condition encountered following delivery, miscarriage, or termination of pregnancy. Retained products of conception (RPOC), enhanced myometrial vascularity (EMV), and uterine arteriovenous malformation (AVM)-like lesions often present with overlapping clinical manifestations, making accurate diagnosis challenging. Misdiagnosis may result in inappropriate interventions, including unnecessary curettage, embolization, or hysterectomy. Ultrasound combined with color Doppler imaging has emerged as the primary diagnostic modality for distinguishing endometrial from myometrial causes of bleeding.

Objectives: To evaluate the role of grayscale ultrasound and color Doppler imaging in differentiating RPOC, EMV, and AVM-like lesions in women presenting with post-pregnancy bleeding and to assess the imaging features associated with clinical management and outcomes.

Materials and Methods: A prospective observational study was conducted on 80 women presenting with abnormal post-pregnancy bleeding at a tertiary care center. All patients underwent transabdominal and transvaginal ultrasound examinations followed by color and spectral Doppler assessment. Imaging parameters including endometrial thickness, presence of endometrial mass, vascularity pattern, peak systolic velocity (PSV), and lesion location were analyzed. Final diagnosis was established through histopathology, angiographic findings, operative findings, or clinical follow-up.

Results: Among 80 patients, RPOC was diagnosed in 44 (55.0%), EMV in 20 (25.0%), AVM-like lesions in 10 (12.5%), and other causes in 6 (7.5%). Thickened endometrium (>15 mm) and endometrial mass were significantly associated with RPOC (p<0.001). Marked vascularity and high PSV (>40 cm/s) were predominantly observed in EMV and AVM-like lesions (p<0.001). Complete symptom resolution occurred in 85% of patients following imaging-guided management. Ultrasound combined with Doppler demonstrated high diagnostic accuracy in differentiating endometrial from myometrial pathology.

Conclusion: Color Doppler ultrasound is an effective first-line imaging tool for distinguishing RPOC from EMV and AVM-like lesions in women with post-pregnancy bleeding. Accurate identification of lesion origin and vascular characteristics facilitates appropriate management while preserving fertility and reducing unnecessary invasive procedures.