Uterine Arteriovenous Malformation: A Rare Cause of Secondary Postpartum Hemorrhage

Caroline Chiew Ping Tan, Manisha Mathur, Richard Hoau Gong Lo

Abstract


Ruptured uterine arteriovenous malformation (AVM) such as uterine artery pseudoaneurysm is an extremely rare cause of secondary postpartum hemorrhage (PPH), thus causing a diagnostic and therapeutic dilemma for the managing obstetricians. We describe a case of a 40-year-old lady who presented with recurrent intractable secondary PPH unresponsive to conventional treatment following an emergency lower segment cesarean section (LSCS). This was her second LSCS for a failed trial of vaginal birth after cesarean section (VBAC). Subsequently left uterine artery extravasation was identified on pelvic angiogram and selective embolization was done with successful treatment of her PPH. To date, there have been only case reports or case series available on literature due to its rarity of the diagnosis. We wish to raise awareness of this rare diagnosis in patients with risk factors as a cause of recurrent PPH not responding to medical management. We also wish to share our experience with the successful use of selective uterine artery embolization for the management of this condition which resulted in avoidance of hysterectomy and its associated morbidity.




J Med Cases. 2017;8(5):152-154
doi: https://doi.org/10.14740/jmc2804w

Keywords


Uterine arteriovenous malformation; Postpartum hemorrhage; Cesarean section; Pelvic angiogram; Uterine artery embolization; Uterine artery pseudoaneurysm

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