A Case of Uterine Arteriovenous Malformation with Retained Products of Conception, Presenting as Secondary Post-Partum Haemorrhage

Abstract

Uterine arteriovenous malformation (AVM) is defined as the rare occurrence of an abnormal and nonfunctional connection between uterine arteries and veins. Bleeding per vaginum is the typical presentation with potential for acute onset, life threatening haemorrhage. Investigations including ultrasound with or without doppler, magnetic resonance imaging [MRI] and angiography are often used to aid in the diagnosis. Management of uterine AVMs depend on the hemodynamic status of the patient, size and site of the lesion, severity of bleeding symptoms, age of the patient, desire for future fertility and treatment expertise available at hand. The therapeutic options available include medications like uterotonic and the combined contraceptive pill, balloon tamponade, surgical removal of the AVM, laparoscopic bipolar coagulation, uterine artery embolization and hysterectomy. The case we report is of a 27-year-old primigravida with acute onset vaginal bleeding, 3 weeks post ventouse delivery. She was resuscitated and investigated and subsequently had uterine artery embolization, prior to having a surgical evacuation of retained products of conception.