Uterine Arteriovenous Malformation Associated With Retained Products of Conception Treated by Selective Arterial...

Uterine arteriovenous malformation is an uncommon but potentially life-threatening cause of abnormal uterine bleeding, particularly after pregnancy-related intrauterine instrumentation. It can mimic or coexist with retained products of conception, and inappropriate curettage may precipitate severe hemorrhage. We report the case of a 27-year-old G1P0 woman who presented with recurrent metrorrhagia, pelvic pain, and two months without a normal menstrual period, five months after an unsupervised termination of pregnancy followed by uterine curettage. She was hemodynamically stable but anemic, with a hemoglobin level of 8.9 g/dL, and serum beta-human chorionic gonadotropin was negative. Transvaginal ultrasonography with color Doppler showed intracavitary material and serpiginous endometrial-myometrial hypervascular channels with turbulent flow. Pelvic magnetic resonance imaging demonstrated posterior myometrial flow voids with early intense enhancement and a dominant arterial supply from the left uterine artery. Pelvic angiography confirmed a high-flow arteriovenous shunt supplied predominantly by the left uterine artery. Selective arterial embolization using absorbable gelatin sponge particles achieved immediate angiographic occlusion of the shunt and clinical control of bleeding. Follow-up ultrasonography at one month showed marked regression, and a six-month examination confirmed complete resolution without recurrent bleeding. This case underscores the importance of considering a uterine vascular lesion in reproductive-age patients with persistent bleeding following pregnancy loss or curettage. Multimodal imaging is essential for distinguishing vascular retained products of conception, enhanced myometrial vascularity, pseudoaneurysm, and uterine arteriovenous malformation. In hemodynamically stable patients desiring future fertility, selective embolization represents an effective fertility-preserving treatment option that avoids the hemorrhagic risks associated with blind curettage.