Uterine Arteriovenous Malformation: Case Series and Literature Review

Abstract

Background: Uterine AV malformation is a rare cause of torrential post-abortal hemorrhage, which can present with varying grades of severity. Diagnosis requires a high degree of suspicion and is done with ultrasound and Doppler.

Case series: In our institution, during the period 2008-2013, five cases of symptomatic uterine AVMs have been reported. All of them were in the reproductive age group (22-36 years), presenting with a history of miscarriage or termination of pregnancy for which curettage was done. The presentation was with recurrent bouts of torrential bleeding, some triggered by second curettage, and not controllable with regular measures. Diagnosis was by ultrasound-gray scale, color Doppler, and spectral Doppler. The time interval between the onset of symptoms and the primary curettage was 8-89 days; four patients underwent selective arterial embolization, and one patient opted for hysterectomy. On follow-up, all the four patients are presently free of symptoms; two of them conceived within 2 years of the procedure and carried the pregnancy to term-one resulting in a live-birth and the other intrauterine death.

Conclusion: Uterine AV malformation should be thought of as a differential diagnosis in all cases presenting with bleeding after miscarriage or curettage, since diagnosis is simple and treatment by selective arterial embolization saves morbidity of surgery and anesthesia, and more importantly reduces hospital stay and the absence from work.

Keywords: Arteriovenous malformation; Gelfoam; Uterine artery embolization; Vascular malformations.

Fig. 1

Angiographic picture of Case 2 showing AV malformation

Fig. 2

Angiographic picture of Case 2 showing cessation of blood flow following embolization

Fig. 3

USG picture of Case 3 showing AV malformation close to the fundus

Fig. 4

USG picture of Case 4 showing the serpiginous vessels on the left side

Fig. 5

USG picture of Case 4 showing Doppler flow with low-resistance high-velocity flow

Fig. 6

Angiographic image of Case 4 showing large AV malformation in the right uterine artery

Fig. 7

USG picture of Case 5 showing AV malformation with feeder vessels