Severe Uterine Hemorrhage Resulting from Uterine Arteriovenous Malformation: A Catastrophic Scenario

Main Article Content

Nur Izzati Ayub
Syed Shahrul Naz Syed Shamsuddin
Engku Ismail Engku-Husna

Abstract

Background: Abnormal uterine bleeding (AUB) is often challenging to diagnose in the Emergency Department (ED) due to its various causes. Uterine arteriovenous malformation (AVM) is a rare but significant gynaecological emergency that is frequently missed. It typically manifests as sudden and heavy vaginal bleeding, posing a potential life-threatening risk that requires immediate attention.


Case Presentation: A 40-year-old para three woman presented to the ED with severe vaginal bleeding. Despite rapid resuscitation, she experienced hemodynamic instability. Uterine AVM was suspected based on colour Doppler pelvic ultrasound and later confirmed by angiography. Successful treatment was achieved with uterine artery embolization with complete resolution of the bleeding.


Conclusion: This case highlights the importance of early recognition and rapid resuscitation in treating uterine AVM with multidisciplinary team approach as a life-saving measure. Transcatheter arterial embolization is highly effective and preferred for preserving fertility in women. Timely intervention is crucial in managing this gynaecological emergency.

Article Details

How to Cite
(1)
Ayub, N. I.; Syed Shamsuddin, S. S. N.; ENGKU ISMAIL, E. H. Severe Uterine Hemorrhage Resulting from Uterine Arteriovenous Malformation: A Catastrophic Scenario. Thai J Obstet Gynaecol 2024, 28.
Section
Case Report

References

Hammad R, Nausheen S, Malik M. A Case Series on Uterine Arteriovenous Malformations: A Life-Threatening Emergency in Young Women. Cureus. 2020;12:e9410.

Yazawa H, Soeda S, Hiraiwa T, Takaiwa M, Hasegawa-Endo S, Kojima M, et al. Prospective evaluation of the incidence of uterine vascular malformations developing after abortion or delivery. J Minim Invasive Gynecol. 2013;20:360-7.

Larcombe J, Stuart A. Acquired uterine arteriovenous malformation-Does it really exist? A case report. Radiol Case Rep. 2023;18:3872-3875.

Jeanmonod R, Skelly CL, Agresti D. Vaginal Bleeding. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470230/

Szpera-Goździewicz A, Gruca-Stryjak K, Bręborowicz GH, Ropacka-Lesiak M. Acquired uterine arteriovenous malformation—a diagnostic dilemma. Ginekologia Polska. 2018;89:228-9.

Phupong V, Aribarg A. Congenital arteriovenous malformations of the uterus. Thai J Obstet Gynaecol 2000;12:67-70.

Cura M, Martinez N, Cura A, Dalsaso TJ, Elmerhi F. Arteriovenous malformations of the uterus. Acta Radiologica. 2009;50:823-829.

Hoffman MK, Meilstrup JW, Shackelford DP, Kaminski PF. Arteriovenous malformations of the uterus: An uncommon cause of vaginal bleeding. Obstet Gynecol Surv. 1997;52:736–40.

Arora R, Achla B, Pinkee S, Purba G, Bharti M. Arteriovenous malformations of the uterus. N Z Med J. 2004;117:U1182.

Easton-Carr RB, Durant EJ, Nguyen AH. Uterine Arteriovenous Malformation (AVM) - a Potentially Life-Threatening Cause of Post-Partum Vaginal Bleeding. Am J Case Rep. 2022;23:e938559.

Agarwal N, Chopra S, Aggarwal N, Gorsi U. Congenital Uterine Arteriovenous Malformation Presenting as Postcoital bleeding: A Rare Presentation of a Rare Clinical Condition. J Clin Imaging Sci. 2017;7:11.

Lee BB, Bergan JJ. Advanced management of congenital vascular malformations: a multidisciplinary approach. Cardiovasc Surg. 2002;10:523-33.

Hashim H, Nawawi O. Uterine arteriovenous malformation. Malays J Med Sci. 2013;20:76-80.

Matsumoto MM, Caridi TM. Uterine Vascular Anomalies: Management and Treatment Overview. Semin Intervent Radiol. 2023;40:342-348.

Mohan PP, Hamblin MH, Vogelzang RL. Uterine artery embolization and its effect on fertility. J Vasc Interv Radiol. 2013;24:925-30.

Habte R, Yosef A, Bedaiwy M. Medical Management of Uterine Arteriovenous Malformation: A Case Series. Eur J Obstet Gynecol Reprod Biol. 2022;274:48-55.

Damiani GR, Dellino M, Cascardi E, Xuamin H, Di Gennaro D, Vimercati A, et al. Uterine venous malformations in the puerperium: 2 Atypical cases and literature review. Eur J Obstet Gynecol Reprod Biol X. 2023;19:100220.