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A Practice Algorithm for Distinguishing Uterine Arteriovenous Malformation in Postpregnancy Hemorrhage
Sadhvi Batra1, Mario Dervishi2, Mohamed Al-Natour2
1Division of Gynecologic Oncology, University of Michigan, Ann Arbor, 48109, Michigan, USA, umich.edu.
Case Reports in Medicine
|December 25, 2025
Summary
Diagnosing uterine arteriovenous malformations (AVMs) can be challenging. This study proposes a new algorithm using ultrasound and hysteroscopy to guide management of AVMs, aiming to improve patient outcomes.
Area of Science:
- Obstetrics and Gynecology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Delayed postpartum hemorrhage requires accurate diagnosis.
- Distinguishing retained products of conception (RPOC) from uterine arteriovenous malformations (AVMs) is clinically challenging.
- Uterine AVMs can cause life-threatening bleeding.
Purpose of the Study:
- To present a case series of patients with suspected uterine AVMs.
- To develop a novel algorithm for the multidisciplinary management of uterine AVMs.
- To improve diagnostic accuracy and treatment planning for uterine AVMs.
Main Methods:
- Case series of five patients with suspected uterine AVMs.
- Development of a management algorithm based on clinical experience.
- Utilized transvaginal ultrasound as the initial diagnostic tool.
- Incorporated diagnostic hysteroscopy and interventional radiology consultation.
Main Results:
- The proposed algorithm prioritizes transvaginal ultrasound for initial assessment.
- The algorithm guides decisions for further imaging or proceeding to hysteroscopy.
- Consultation with interventional radiology is recommended for urgent cases.
Conclusions:
- The study introduces a practice algorithm for managing suspected uterine AVMs.
- This algorithm aims to facilitate multidisciplinary care for a potentially life-threatening condition.
- Further research is needed on conservative management strategies for uterine AVMs.
