Uterine arteriovenous vascular malformation (AVM) masked by gestational trophoblastic disease (GTD): Diagnostic challenge and subsequent treatment

Abstract

Uterine arteriovenous malformations is a life threatening condition due to multiple arteriovenous fistulous communications within the uterus without an intervening capillary network. It can be either congenital or acquired lesions, but associated with uterine AVM following GTD is a rare condition; when these occur in a pregnant patient or in the immediate postpartum period, clinical presentation may overlap with several other entities such as retained products of conception (RPOC), postpartum endometritis, as well as GTD. Material and Methods: We present a case of a GTD masked with UAVM presented with life-threatening vaginal bleeding several months after dilatation and curettage (D&C) of missed abortion. Initially managed W medically with methotrexate and finally required a interventional radiology procedure of embolization as a fertility saving procedure. Conclusion: Uterine AV malformation is a potentially life-threatening condition and prompt diagnosis is required to treat the condition. Uterine artery embolisation should be offered in women as fertility saving measure. Hysterectomy should be used as a last resort of treatment in such patients and should be considered in women with post-menopausal bleeding and in women with life threatening conditions.