Uterine arteriovenous malformation: conservative approach in its management

Uterine arteriovenous malformations (UAVM) are diagnosed more commonly in modern times due to increasing surgical interventions, abortions and better diagnostic modalities. They pose the risk of life-threatening morbidity due to profuse haemorrhage. This case series describes three cases where vaginal bleeding continued post miscarriage, a pelvic ultrasound with Doppler imaging and MR angiography or CT angiogram confirmed a UAVM masquerading as retained products of conception. Dilatation and curettage of the uterus could have been potentially devastating. These patients were successfully managed with hormonal treatment. They were given letrozole tablets and gonadotrophin analogues intramuscularly with complete resolution of the bleeding and UAVM, thus preventing any possible major surgical intervention like a hysterectomy. This case series underscores the fact that fertility preservation with only medical management is possible despite a life-threatening condition like UAVM. This, however, depends on the haemodynamic stability of the patient and the size of UAVM.