Postabortal Bleeding: A Diagnostic Dilemma Resolved As Arteriovenous Malformation and Successfully Managed With Uterine Artery Embolization

Abstract

Uterine arteriovenous malformations (AVM) are rare and may be missed in routine clinical practice, often concealing their existence until dire consequences emerge. This potentially lethal condition can manifest abruptly, with torrential postabortal bleeding, as a grim reminder of its risky nature. Here, we present a rare case of para 1, living 1, abortion 2, initially subjected to dilatation and evacuation due to a missed abortion at a peripheral healthcare facility, subsequently developing torrential bleeding despite all the conservative measures. So she was referred to our hospital in view of heavy vaginal bleeding following the earlier instrumentation; the differential diagnosis of molar pregnancy and AVM was made clinically. As per speculum examination, the presence of remnants of abortion was seen, and the possibility of an invasive mole was suspected. Ultrasonography with color Doppler showed uterine AVM, which was further confirmed by magnetic resonance imaging (MRI). In order to save her life while preserving the uterus, a multidisciplinary approach was involved in managing this patient, consisting of interventional radiologists to perform uterine artery embolization (UAE).

Keywords: abortion; case report; enhanced myometrial vascularity; ultrasonography; uterine arteriovenous malformations; uterine artery embolization.

Figure 1. Ultrasound suggestive of invasive mole

The arrow depicts a well-defined heterogeneous structure with cystic areas within the endometrium.

Figure 2. Uterine AVM on color Doppler

The arrow depicts enhanced myometrial vascularity with evidence of other hyperechoic areas. AVM, arteriovenous malformation

Figure 3. MRI suggestive of uterine arteriovenous malformation

The image depicts features likely suggestive of enhanced myometrial vascularity with hypervascular (type III) retained products of conception. MRI, magnetic resonance imaging

Figure 4. MRI suggestive of blood clots

The contrast image depicts scattered foci of non-enhancing T1W high-intensity areas showing blooming of GRE likely suggestive of blood clots. MRI, magnetic resonance imaging; GRE, gradient recalled echo