Uterine arteriovenous malformation: An obstetrician's nightmare!!

Abstract

Secondary post partum hemorrhage (PPH) is usually defined as excessive vaginal bleeding in the first 24 hours following delivery up to 6 weeks postpartum. There are multiple causes for secondary PPH, rarest of rare being an arteriovenous malformation (AVM). Most cases of secondary PPH are associated with minor morbidities but may still require re-admission to hospital. Uterine AVM as a cause of secondary PPH can lead to severe morbidity and mortality in the mother if not managed immediately. Therefore, an accurate diagnosis and rapid treatment can have a significant impact on a patient's prognosis. In the present case, the patient approached the casualty for torrential vaginal bleeding three weeks after an uncomplicated normal delivery. She was diagnosed with an AVM by an urgent Doppler ultrasonography and treated with super selective uterine artery embolization (UAE) leading to a full recovery. Here the authors report the usefulness of Interventional Radiology in treatment of uterine AVM causing delayed PPH with the idea of uterus sparing modality in the light of this case.