Pregnancy after uterine arteriovenous malformation–case series and literature review

Abstract

Purpose: To perform a retrospective audit of cases of uterine arteriovenous malformations (UAVM) at The Canberra Hospital and review of recent literature reporting pregnancies occurring after the diagnosis of UAVM aiming to devise a diagnostic and treatment protocol to optimise pregnancy post UAVM. Methods: A retrospective audit of cases of UAVM at the Canberra Hospital from a prospectively managed patient database was performed. A search of the electronic database PubMed, for articles between 2000–2011 relating to pregnancy post UAVM. Individual case studies were analysed separately to case series. Results: The study included 28 individual studies and five case series (61 women). Average age was 29.5 ± 6.7 (range 18–42). Most women (24, 85.7%, 100% in case series) presented with abnormal vaginal bleeding; 11 (41%) individuals presented post interruption of pregnancy. All women had had a previous pregnancy (mean gravidity 3.1 ± 3.1, range 1–15 for case studies) and only four women (14.2 %) had no history of uterine trauma. Only one woman (3.6 %) did not have any ultrasound and most women underwent colour Doppler ultrasonography (20, 71.4% in case studies; 61, 83.6% in case series). Of the women, 72 (53.6 % of case studies, 78.1 % of case series) were treated with uterine artery embolisation, seven (25%) were treated expectantly. A total of 63 pregnancies occurred post treatment, seven (13.9%) ending in miscarriage. Average time to conceive post diagnosis was 19 months ± 16.3 (range 2–72). A total of 54 healthy infants were born to mothers post AVM diagnosis. Conclusion: UAVM are likely to exist on a continuum with other pregnancy related pathologies, such as sub involution of the placental bed, making a single best diagnostic and treatment plan difficult. However, this study shows that successful uncomplicated pregnancy is achievable for women after the diagnosis of UAVM.

Uterine Arteriovenous Vascular Malformation Masked by Partial Molar Pregnancy: Diagnostic Challenge and Subsequent Embolic Treatment

“…Included in the differential diagnosis are RPOC, GTD [3,5,8,14], hemangioma, varicosities, uterine malignancies [3,5], subinvolution [5,14], fluid-filled bowel loops, mulit-locular ovarian cysts, and hydrosalpinx [3]. The use of color Doppler with spectral analysis can characterize the grayscale findings further [8].…”

Uterine arteriovenous malformations: clinical implications

“…Congenital lesions classically present with severe menorrhagia, unresponsive to conventional therapy . Acquired or traumatic AVMs are invariably associated with one of the risk factors previously mentioned.…”

“…In a retrospective audit at Canberra Hospital, 27 women who were treated for uterine AVMs achieved 34 pregnancies and 31 live births . Reassuringly, none of these women experienced any complications such as severe growth restriction or adherent placenta (accreta).…”

“…It is suggested that these pregnancies may be at risk of fetal growth restriction, malpresentation, uterine atony and uterine rupture . Other reported complications include miscarriage (13.9%), difficulties in conceiving and preterm labour (22%), and postpartum complications such as postpartum haemorrhage (13.9%) …”

“…The absence of uterine rupture in women who laboured following treatment for AVM should provide confidence in recommending a normal vaginal delivery …”