Case report of massive haemorrhage following medical miscarriage requiring uterine artery embolization

Abstract

Uterine arteriovenous malformations (AVM) are an abnormal, nonfunctional connection between uterine arteries and veins. These occur mostly after damage to uterine tissue following uterine surgical procedures. They may occur following even spontaneous abortion and resolve with expectant management without requiring a medical/surgical intervention. We report an interesting case of a woman who presented after medical abortion with uterine AVM with heavy bleeding requiring radiological intervention. Mrs. K, multiparous woman was referred in hypovlomeic shock from a district hospital. She had a medical abortion with Misoprostol at 9 weeks of gestation 2 months ago. No history of any curettage. She was stabilized and received appropriate transfusions. Sonography revealed a normal size uterus, with retained products of conception adjacent to a focal echogenic mass of size 5.8×4.6 cm in the posterior myometrium, with vascularity into and outward from the lesion suggestive of an AVM. The same was confirmed by CT angiography and an urgent uterine artery embolization (UAE) was undertaken. She withstood the procedure and recovered well. Anticipating spontaneous resolution of the retained products of conception, she was discharged home after clinical improvement and advised permanent method of contraception. Uterine AVM should be suspected in a woman who presents in child bearing age with heavy bleeding per vaginum following childbirth/abortion. Attempts of curettage may prove to be fatal in such scenarios. A high index of suspicion can help in an early diagnosis and seeking appropriate interventional assistance.