A dangerous mimic of retained products of conception: acquired uterine arteriovenous malformation

Abstract

Uterine arteriovenous malformation (AVM) is a rare but potentially life-threatening vascular abnormality characterized by abnormal communication between uterine arteries and veins without an intervening capillary bed. Although congenital AVMs occur infrequently, acquired lesions are increasingly recognized following uterine instrumentation, caesarean delivery, miscarriage, or dilation and curettage. Early diagnosis is essential because inappropriate uterine evacuation may precipitate catastrophic hemorrhage. This report demonstrates a case of a 28-year-old multiparous woman who presented with severe vaginal bleeding one month after suction evacuation for a missed abortion at 12 weeks of gestation. On admission, she was hemodynamically stable but moderately anemic with a hemoglobin of 9 g/dl and serum β-human chorionic gonadotropin (β-hCG) of 73.72 mIU/ml. Transvaginal ultrasonography with color Doppler demonstrated multiple tortuous vascular channels within the posterior myometrium exhibiting high-velocity turbulent flow suggestive of uterine AVM. Computed tomography angiography confirmed an acquired AVM involving branches of the uterine artery. The patient underwent successful bilateral uterine artery embolization using foam gel particles, resulting in immediate cessation of bleeding. Repeat evacuation for retained products of conception was safely performed after embolization. She recovered uneventfully and was discharged on postoperative day four. This case highlights the importance of considering uterine AVM in women presenting with delayed post-abortal hemorrhage. Prompt diagnosis using Doppler ultrasonography and CT angiography followed by uterine artery embolization can effectively control bleeding while preserving fertility.