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Decidualization is the process of endometrial change in pregnancy, a phenomenon that can involve also ovarian endometriomas. However, the frequency of this event remains unknown. In addition, there is no evidence on the decidualization of deep invasive endometriosis (DIE). To shed more light on this issue, we prospectively recruited women with ovarian endometriomas or DIE who underwent IVF. They were subsequently excluded if they did not become pregnant or if they had a miscarriage. The evaluation was repeated in 5 time points during pregnancy and post-partum. The primary outcome was the rate of decidualized endometriomas at 11-13 weeks’ gestation. Data from 45 endometriomas and 15 nodules were available for data analyses. At the 11-13 weeks’ ultrasound, endometriomas’ decidualization was observed in seven cases, corresponding to 16% (95%CI: 8-29%). Subsequent assessments in pregnancy failed to identify any additional case. DIE also underwent significant changes during pregnancy. An increase in mean diameter (at least 50%), an increase in color score or both were documented in seven, eight and five cases, respectively. In conclusion, decidualization of ovarian endometriomas in IVF pregnancies is common. DIE may also undergo decidualization, but further evidence is needed for a robust and shared definition of this process.

Objective(s): To evaluate the “flow void” diameter in patients with pregnancy-related diseases with and without uterine AVMs and assess the diagnostic performance of unenhanced MRI for uterine AVMs.Study Design: From May 2014 to April 2019, 79 patients with pregnancy-related diseases were included, including 36 with and 43 without uterine AVMs confirmed by DSA. On MRI, the diameter of the most prominent “flow void” (hereinafter referred to as fv-D) was measured and compared between patients with and without uterine AVMs. The diagnostic performance of fv-D was estimated with receiver operating characteristic curves.Results: The “flow void” sign was observed in patients with and without uterine AVMs (P>0.05). The fv-D was significantly larger in patients with uterine AVMs in the myometrium and parametrium than in patients without uterine AVMs (P1.33 mm) and parametrium (sensitivity: 97.22%, specificity: 67.44%, AUC: 0.881, cut-off:>2.6 mm). Conclusions: On MRI, fv-D could diagnose uterine AVMs. The fv-D had a much higher diagnostic efficiency in the parametrium than in the myometrium. The parametrium fv-D greatly improved the diagnostic sensitivity and provides a more accurate, noninvasive method of investigating possible uterine AVMs.