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Review
. 2020 Jul 31;99(31):e21432.
doi: 10.1097/MD.0000000000021432.

Cesarean scar pregnancy combined with arteriovenous malformation successfully treated with transvaginal fertility-sparing surgery: A case report and literature review

Xiangjuan Li  1 , Wenchao Sun  2 , Lingna Chen  2 , Mei Jin  1 , Zhifen Zhang  3 , Jiansong Gao  4 , Xiaoyang Fei  2
Affiliations
Review

Cesarean scar pregnancy combined with arteriovenous malformation successfully treated with transvaginal fertility-sparing surgery: A case report and literature review

Xiangjuan Li et al. Medicine (Baltimore). .

Abstract

Introduction: A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging.

Patient concerns: We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment.

Diagnoses: A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging.

Interventions: Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident.

Outcomes: The fertility of the patient was preserved and hysterectomy was avoided.

Conclusion: Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.

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Conflict of interest statement

The authors have no funding and conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Transvaginal ultrasound image. A. Grayscale sagittal image showing a 5.4 × 5.0 cm2 lesion (dashed circle) at the anterior isthmic region of the uterus. B. Grayscale coronal image showing an echo-free tubular structure up to 1.0 cm in width within the lesion (arrow). C. Color Doppler imaging showing enhanced vascularity surrounding and within the lesion. D. Three-dimensional color Doppler angiogram showing the arteriovenous malformation and the feeding (A) and draining (V) vessels.
Figure 2
Figure 2
T1-weighted contrast-enhanced magnetic resonance imaging showing an enlarged vessel (red arrow) in the gestational mass, which is consistent with arteriovenous malformation. A. Sagittal view. B. Horizontal view.
Figure 3
Figure 3
Transvaginal surgery. A. Ectopic gestation removed from the uterine defect (arrow). B. Uterine defect repaired.
Figure 4
Figure 4
Surgical specimen. A. Ectopic gestation and blood clots removed from the anterioruterine segment. B. Photomicrograph of trophoblasts (arrow, hematoxylin and eosin stain, 40 × magnification).
Figure 5
Figure 5
Kinetics of the serum β-hCG level and the corresponding treatment (day of hospitalization = day 0).
See this image and copyright information in PMC

References

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