Imaging and hysteroscopic findings in a patient with postpartum hemorrhage caused by acquired uterine arteriovenous fistulas

Abstract

A 24-year-old woman (gravida 2, para 1, aborta 1) gave birth to a healthy 3.11 kg full-term female baby, with Apgar scores of 10 and 10 at 1 and 5 min, respectively, via spontaneous vaginal delivery at our obstetrics inpatient department. A lateral episiotomy was repaired, and B-ultrasonography revealed that the placenta was lodged in the anterior wall of the uterus, about 31 mm thick, grade III maturity (Figure 1a). Eventually, the entire placenta ejected itself without complications 9 min after the delivery of the baby. The woman's immediate postpartum course was unremarkable, and bleeding was minimal; she lost about 400 ml of blood during delivery and the post-delivery procedure. However, her hemoglobin levels and platelet counts suddenly dropped from 12.0% prenatal to 7.1% postnatal and from 143 prenatal to 107 postnatal, respectively. Because she had had an arrested intrauterine pregnancy a year before this incidence, she underwent dilation and evacuation (D&E) and was discharged from the hospital on postpartum day 2.