Arteriovenous malformation of the uterus after a midtrimester loss: A case report

BACKGROUND: Arteriovenous malformations (AVMs) of the uterus are rare but potentially life-threatening lesions. The typical presentation includes intermittent, heavy and profuse vaginal bleeding, often refractory to medical therapy. CASE: We present the case of a 25-year-old woman presenting 18 months after a 22-week pregnancy loss complicated by a postpartum curettage for retained placenta. The patient's initial symptoms included irregular and extremely heavy vaginal bleeding. Several transfusions of packed red blood cells were required because of severe anemia. On transfer to our institution, evaluation with ultrasound and hysteroscopy revealed a large AVM in the fundus of the uterus, apparently fed by both the right and left uterine arteries. After 2 embolization procedures of the uterine arteries, the patient experienced a recurrence of her symptoms, requiring definitive treatment with a hysterectomy. CONCLUSION: AVMs of the uterus are a rare cause of vaginal bleeding. AVMs should be considered in the differential diagnosis for the patient with bleeding refractory to medical management and a history of prior uterine surgery. Although unsuccessful in our case, uterine artery embolization remains a viable treatment option, particularly in patients wishing to retain their reproductive capacity.