Arteriovenous malformations: A rare cause of postpartum hemorrhage. A case report

Uterine Acquired Arteriovenous Malformations are rare abnormalities that can cause postpartum hemorrhage, they are characterized by an abnormal connection between high-pressure arteries and low-pressure veins, which can result in symptoms ranging from pelvic pain to severe, life-threatening hemorrhages. Diagnosis and treatment can be performed via angiography.

A 32-year-old patient, with no significant medical history, underwent an uncomplicated cesarean section. Fifteen days postpartum, she was admitted to the emergency department for severe uterine hemorrhage, presenting with hemodynamic instability. Transvaginal ultrasound with Doppler revealed a uterine arteriovenous malformation. Due to her unstable condition, she underwent a hysterectomy following a blood transfusion.

UAVMs can result from intrauterine trauma such as cesarean sections, abortions, or retained trophoblastic tissue. Symptoms include abnormal uterine bleeding, often associated with traumatic events. Diagnosis primarily relies on pelvic ultrasound with Doppler, which can suggest the presence of a UAVM. Angiography remains the gold standard, providing both diagnostic confirmation and therapeutic options, including embolization, which can be performed during the same procedure. The treatment of UAVMs depends on the clinical condition of the patient and her desire for future pregnancies. Embolization is the treatment of choice for stable patients, while hysterectomy is considered in cases of hemodynamic instability or bleeding resistant to embolization.

The diagnosis of UAVMs should be considered in cases of persistent abnormal uterine bleeding after delivery to determine appropriate treatment. Embolization is regarded as the gold standard treatment as long as the patient's hemodynamic condition allows it.