Uterine arteriovenous malformations (AVM) are a rare cause of obstetrical hemorrhage. It can be congenital or acquired secondary to Dilation and Curettage, cesarean section, gestational trophoblastic disease or uterine malignancies. Uterine AVM can cause postpartum hemorrhage, and frequently misdiagnosed behind this context. In this case a uterine curettage could result in disastrous consequence. Uterine Arteriovenous anomalies can be suspected based on History and Physical exam; diagnosed with CT scan, Color Doppler ultrasound, MRA and Arterial embolization. Treatment of Uterine AVM is Hysterectomy or less invasive fertility sparing procedure like uterine artery embolization.METHODS:
Chart review; Literature review.RESULTS:
A 30 year old presented to the emergency department seventeen days after a Cesarean delivery complaining of heavy vaginal bleeding. Ultrasound showed nonspecific thickening of the endometrium with minimal fluid in endometrial cavity. Three days later the patient returned with the same complaints and was hypotensive and tachycardic. Ultrasound showed suspected retained Products of conception; and endometrial curettage was performed. Six after discharge she returned with vaginal bleeding and a vascular anechoic structure on ultrasound suspicious for pseudoaneurysm. On Pelvis CT as AV fistula of 21 mm was diagnosed. Left Uterine artery embolization was performed. Symptoms resolved and repeat CT scan showed resolution of the fistula.CONCLUSION:
Uterine arteriovenous malformation is a rare cause of postpartum hemorrhage that can be life threatening if not identified in timely fashion. Uterine artery embolization is an excellent treatment option with fertility sparing benefit.