Trans-arterial embolization of acquired uterine arteriovenous malformation after Cesarean section: A case series

• Published in: Iranian journal of reproductive medicine Vol. 17; no. 2
• Main Authors: Harzif, Achmad Kemal, Haloho, Agrifa, Silvia, Melisa, Pratama, Gita, Purwosunu, Yuditiya, Wibawa, Aria, Sidipratomo, Prijo, Pandelaki, Jacub
• Format: Journal Article
• Language: English
• Published: Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences of Yazd 05-09-2019
• Subjects: Acquired uterine arteriovenous malformation; Cesarean section; Trans-arterial embolization
• ISSN: 1680-6433

Background: Acquired uterine arteriovenous malformation (AVM) is a rare
condition due to traumatic episodes in cesarean section. The patient
can suffer from life-threatening hemorrhage or recurrent vaginal
bleeding. Establishing this diagnosis is difficult, often misdiagnosed
due to lack of information and number of cases. Trans-Arterial
Embolization (TAE) procedure is rarely performed in our center. All of
the cases were found with history of massive bleeding and diagnosed
lately after recurrent bleeding history. Even though promising, one of
our cases failed to be managed with TAE. It is important to diagnose
early symptoms of AVM in order to prevent the life threatening event.
Case presentation: In these case series, four cases of AVMs after
cesarean procedures will be reviewed. One could be diagnosed in less
than a month but the other three took several months. The symptom of
vaginal bleeding might occur a few weeks after the procedure is done,
and most patients need transfusion and hospitalization. Three out of
four patients were initially sent to the hospital in order to recover
from shock condition, and one patient was sent for a diagnostic
procedure. AVMs diagnostic was established with ultrasound with or
without angiography. Three of our cases were succeeded by performing
TAE procedure without further severe vaginal bleeding. One case failed
to be treated with embolization and had to proceed with hysterectomy.
Conclusion: AVM should be considered early-on in patient with abnormal
uterine bleeding and history of cesarean section. Embolization is still
the first-choice treatment of AVMs, otherwise definitive treatment is
hysterectomy in a patient without fertility need, or impossible to
perform TAE.