Vein of Galen Aneurysmal Malformations (VGAM) are complex arteriovenous malformations of the pediatric age group characterized by shunting of blood from the arterial to the vnous system resulting in high-output cardiac failure, hydrocephalus, PHTN and irreversible neurological damage if not detected and treated promptly. Here, we report the case of a true choroidal type VGAM detected antenatally that was complicated by disseminated intravascular coagulation. We will be discussing the diagnostic approach, the in-hospital course and the treatment modalities implied to manage the associated complications along with the treatment plan tailored for our patient.
Patient: Female, 31-year-old
Final Diagnosis: Chorioamnionitis
Symptoms: Nasal congestion • PPROM • rhinorrhea
Clinical Procedure: —
Specialty: Obstetrics and Gynecology
Objective:
Unusual clinical course
Background:
Cervical incompetence and deformities contribute significantly to mid-trimester pregnancy losses and preterm births. Abdominal cerclages prevent these complications, particularly in patients with a history of failed vaginal cerclage or severe cervical deformities. However, pregnancy complications such as chorioamnionitis and fetal demise may necessitate cerclage removal. The removal methods vary, with the least invasive being the colpotomy approach, associated with lower morbidity rates than the transabdominal approach or laparoscopy.
Case Report:
We detail a case involving a 31-year-old woman with a twin pregnancy at 18 weeks gestation, complicated by COVID-19 and chorioamnionitis. This clinical scenario necessitated the removal of an abdominal cerclage. Given the patient's risk profile, a posterior colpotomy approach was deemed most suitable.
Conclusions:
The posterior colpotomy approach provided an effective and less risky method for abdominal cerclage removal in a high-risk patient. It successfully mitigated the potential complications of general anesthesia and operative risks associated with laparoscopy/laparotomy, offering optimal operative conditions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.