Uterine Arteriovenous Malformation as a Cause of Secondary Postpartum Hemorrhage: A Case Report

Abstract

ABSTRACT Background Uterine arteriovenous malformation (AVM) is a very rare cause of secondary postpartum hemorrhage (PPH) which might present along with retained products of conception (RPOC). Despite being a rare entity, it is a life-threatening condition and hence high degree of suspicion is required for prompt diagnosis and appropriate treatment as certain procedures, such as instrumental evacuation, commonly performed for RPOC could be devastating. With the recent advancements, color Doppler ultrasonography has become a preferred noninvasive method for diagnosing AVM though angiography remains the gold standard for diagnosis. Case description This case report describes a 36-year-old multiparous woman who presented 3 weeks after delivery by lower segment cesarean section (LSCS) with secondary PPH. Transabdominal ultrasound (TAS) revealed an involuting uterus with an ill-defined hypoechoic area within the myometrium adjacent to the endometrium with significant intrinsic vascularity raising the suspicion of placenta accreta. Magnetic resonance imaging (MRI) with contrast was performed for confirmation which showed an AVM with coexistent RPOC. Since the patient did not give consent for uterine artery embolization which was offered to her during counseling, hysterectomy was carried out. Histopathological diagnosis of uterine AVM was conclusive. Conclusion Arteriovenous malformation, although a rare entity, should be ruled out in a patient presenting with hemorrhage after delivery/miscarriage even if the imaging shows the presence of RPOC by the diagnostic modalities available so that appropriate treatment can be instituted. How to cite this article Sambashivaiah J, Velayudam L, Tigga M, et al. Uterine Arteriovenous Malformation as a Cause of Secondary Postpartum Hemorrhage: A Case Report. J South Asian Feder Obst Gynae 2020;12(3):188–191.