Acquired uterine arteriovenous malformation in a cesarean scar pregnancy

Abstract

The recent exponential increase in the rate of cesarean sections has been associated with an increase in placentation complications during subsequent pregnancies [1]. A cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy that results from faulty implantation within a previous cesarean section scar. CSP may be life-threatening because of subsequent uterine rupture and uncontrolled hemorrhage that require a hysterectomy. Uterine arteriovenous malformation (AVM), which is an abnormal connection between arteries and veins [2], can be caused by iatrogenic events or pathologic pelvic conditions. With the progress in imaging techniques such as computed tomography (CT) and magnetic resonance angiography, uterine AVM has been reported as one of the complications in CSP cases [3e5]. Although the coexistence of uterine AVM and CSP is potentially life-threatening, optimal management of CSP with uterine AVM has not been determined because it is so rare. We report a case of CSP complicated by uterine AVM and describe how the patient’s fertility was preserved using a combined conservative management approach. A 32-year-old patient (gravida 3, para 2) was referred for suspicion of a gestational trophoblastic tumor. She had experienced persistent and painless vaginal bleeding for approximately 8 weeks, and ultrasound showed a tumor in the anterior part of the uterus. The patient had a first cesarean section delivery for breech presentation. She gave birth to a second baby by elective cesarean section 2 years prior to presentation for the current problem. This pregnancy was followed by one missed abortion during the first trimester, for which she underwent uterine evacuation.