Uterine arteriovenous malformation leading to postpartum hemorrhage: A case report

Abstract

Uterine arteriovenous malformation (AVM) is an uncommon but potentially life-threatening cause of postpartum hemorrhage (PPH). AVMs often present with intermittent or profuse vaginal bleeding in a woman with a history of uterine instrumentation. Transvaginal ultrasound is the initial imaging method used for diagnosis. Management depends on the patient's hemodynamic stability and desire for future pregnancy. Uterine artery embolization (UAE) is the initial treatment option for women of reproductive age. Due to limited evidence, there are no guidelines for the management of failed UAE. Here we report a case of uterine AVM following a cesarean section that failed initial management with UAE and required emergency hysterectomy.

Uterine Arteriovenous Malformation: A Pictorial Review of Diagnosis and Management

“…63,64 In the case of unstable hemodynamics, intravenous fluid resuscitation must be initiated as well as blood products must be used early in the process. 65 A Foley catheter can work to stem the bleeding in the situation of lifethreatening hemorrhage. 66 Patients with minor bleeding and stable hemodynamic status can receive conservative treatment.…”

“…32 The scheme of diagnostic and treatment are shown in Figure15. 19,21,[44][45][46][47][48][63][64][65][66][67][68][69][70]…”

“…82,83 One proposed hypothesis is that endothelial dysfunction that produces AVM is caused by increased activity of the kinase MAP2K1, also known as MEK1. MEK1 inhibitors are used in cancer 19,21,[44][45][46][47][48][63][64][65][66][67][68][69][70] meandering vessels in the myometrium and parametrium. The uterine wall is also slightly thick.…”

“…Figure 15.Approach to diagnosis and treatment of uterine arteriovenous malformation (UAVM) 19,21,[44][45][46][47][48][63][64][65][66][67][68][69][70]. …”

Iatrogenic uterine injury leading to uterine arteriovenous malformation

“…Congenital cases have multiple communications between artery and vein, while acquired ones typically have a single communication [2] . In addition, while congenital cases are extremely rare, the incidence of acquired cases—which occur most commonly secondary to dilatation and curettage (D&C), pelvic surgery, therapeutic abortion, gestational trophoblastic neoplasia, infection, direct trauma, and gynaecological malignancies [3] —has increased owing to increased instrumentation.…”