Background: Uterine arteriovenous malformation (AVM) is a very rare cause of secondary postpartum hemorrhage (PPH) which might present along with retained products of conception (RPOC). Despite being a rare entity, it is a life-threatening condition and hence high degree of suspicion is required for prompt diagnosis and appropriate treatment as certain procedures, such as instrumental evacuation, commonly performed for RPOC could be devastating. With the recent advancements, color Doppler ultrasonography has become a preferred noninvasive method for diagnosing AVM though angiography remains the gold standard for diagnosis. Case description: This case report describes a 36-year-old multiparous woman who presented 3 weeks after delivery by lower segment cesarean section (LSCS) with secondary PPH. Transabdominal ultrasound (TAS) revealed an involuting uterus with an ill-defined hypoechoic area within the myometrium adjacent to the endometrium with significant intrinsic vascularity raising the suspicion of placenta accreta. Magnetic resonance imaging (MRI) with contrast was performed for confirmation which showed an AVM with coexistent RPOC. Since the patient did not give consent for uterine artery embolization which was offered to her during counseling, hysterectomy was carried out. Histopathological diagnosis of uterine AVM was conclusive. Conclusion: Arteriovenous malformation, although a rare entity, should be ruled out in a patient presenting with hemorrhage after delivery/miscarriage even if the imaging shows the presence of RPOC by the diagnostic modalities available so that appropriate treatment can be instituted.
Women's health case of the day: uterine arteriovenous malformation. AJR Am J Roentgenol 1994;162(6):1457–1462. DOI: 10.2214/ajr.162.6.8192024.
Successful pregnancy after selective embolisation of a post-molar vascular malformation. Case report. Br J Obstet Gynaecol 1988;95(8):814–817. DOI: 10.1111/j.1471-0528.1988.tb06557.x.
Uterine arteriovenous malformation—a rare cause of uterine haemorrhage. Aust N Z J Obstet Gynaecol 1994;34(2):197–199. DOI: 10.1111/j.1479-828X.1994.tb02691.x.
Uterine arteriovenous malformations: from diagnosis to treatment. J Ultrasound Med 2006;25(11):1387–1392. DOI: 10.7863/jum.2006.25.11.1387.
Prospective evaluation of the incidence of uterine vascular malformations developing after abortion or delivery. J Minim Invasive Gynecol 2013;20(3):360–367. DOI: 10.1016/j.jmig.2012.12.008.
Vascular abnormalities of the uterus: have we recently over diagnosed them? Ultrasound Obstet Gynecol 2003;21(6):529–531. DOI: 10.1002/uog.163.
Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv 2005;60(11):761–767. DOI: 10.1097/01.ogx.0000183684.67656.ba.
Arteriovenous malformation of the uterus associated with secondary postpartum hemorrhage. Ultrasound Obstet Gynecol 2003;21(6):602–605. DOI: 10.1002/uog.148.
Obstetric iatrogenic arterial injuries of the uterus: diagnosis with us and treatment with transcatheter arterial embolization. Radiographics 2002;22(1):35–46. DOI: 10.1148/radiographics.22.1.g02ja0735.
Arteriovenous malformations of the uterus. Obstet Gynecol 1989;73(2):209–214.
Diagnosis and nonsurgical management of uterine arteriovenous malformation. Cardiovasc Intervent Radiol 2007;30(6):1267–1270. DOI: 10.1007/s00270-007-9100-z.
Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations. Ultrasound Obstet Gynecol 2003;21(6):570–577. DOI: 10.1002/uog.159.
Disappearance of a uterine arteriovenous malformation following long-term administration of oral norgestrel/ethinyl estradiol. J Obstet Gynaecol Res 2014;40(6):1807–1810. DOI: 10.1111/jog.12370.
A systematic review of acquired uterine arteriovenous malformations: pathophysiology, diagnosis and transcatheter treatment. Am J Perinatol Rep 2016;6(1):e6–e14. DOI: 10.1055/s-0035-1563721.
Laparoscopic management of uterine arteriovenous malformation via occlusion of internaliliacarteries. J Minim Invasive Gynecol 2012;19(6):785–788. DOI: 10.1016/j.jmig.2012.07.009.
Uterine arteriovenous malformation: fertility-sparing surgery using unilateral ligation of uterine artery and ovarian ligament. Int J Gynecol Cancer 2007;17(3):735–737. DOI: 10.1111/j.1525-1438.2007.00884.x.