But there is no case of cervical avm in pregnant uterus. The advantages of this procedure are that it is minimally invasive and can be performed under local anesthesia, it preserves the uterus and if the site of hemorrhage can be accurately identified, selective embolization can be performed with minimal disruption of the normal vascular supply to the uterus. Uterine malformation sometimes is referred to as mullerian anomalies. Uterine arteriovenous malformation avm is a rare condition, with fewer than 100 cases reported in the literature. Barbieri, in yen and jaffes reproductive endocrinology eighth edition, 2019. Uterine arteriovenous malformations uavm are uncommon entities and should be considered in patients who present with profuse genital tract bleeding. Arteriovenous malformations and retained products of. Although they are considered relatively rare, with fewer than 150 cases reported in the literature, the true incidence of uterine avms may be higher.
Congenital avms are the result of abnormal vascular differentiation kasznica and nisar, 1995, while acquired avms may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease frencken and landman, 1965. Uterine arteriovenous malformations obstetrics and gynecology. Pdf uterine arteriovenous malformation avm is a rare condition, with fewer than 100 cases reported in the literature. An exception to congenital avm is dural arteriovenous malformation, which is generally acquired. Although the patients typically present with vaginal bleeding, some patients may experience lifethreatening massive bleeding in some circumstances.
Uterine arteriovenous malformation avm is a vascular hamartoma of the myometrium characterized by the presence of shunts between the myometrial arteries. Pelvic ultrasonography and magnetic resonance imaging revealed a left uterine arteriovenous malformation. Mar 17, 2015 uterine av malformation is a rare cause of torrential postabortal hemorrhage, which can present with varying grades of severity. Uterine av malformation is a rare cause of torrential postabortal hemorrhage, which can present with varying grades of severity. Despite it being rare, it is a potentially lifethreatening condition. True incidence of congenital uterine anomalies is unknown. Uterine arteriovenous malformations avms are rare causes of gynaecologic bleeding. The patient was successfully treated with a hysterectomy with salpingooophorectomy.
As the development of doppler ultrasonography, many cases of uterine arteriovenous malformation avm have beed diagnosed. In our institution, during the period 200820, five cases of symptomatic uterine avms have been reported. T2wieatghed images of the pelvis at the level of the uterus show abnormal hypo intense focusflow void along the anterior upper endometrial cavity that extend into the myometrial white arrow in a, b and c. Uterine malformation an overview sciencedirect topics. Uterine arteriovenous malformation avm is an uncommon vascular disease, which can be a lifethreatening condition. These can be either congenital or acquired lesions traumatic lesions. Typically, one is born with an avm, and as he grows older, the size of the malformation increases, but it does not spread as cancer may. Uavms can cause lifethreatening massive bleeding in young women. Uterine arteriovenous malformation avm is a rare vascular condition. Spectral doppler us revealed lowresistance flow ri, 0. This entity is generally associated with the presence of molar disease, choriocarcinoma and. Uterine arteriovenous anomalies can be suspected based on history and physical exam. Uterine arteriovenous malformation uavm is a rare condition that affects women of reproductive age and clinically presents with unexplained profuse bleeding par vagina.
Sagittal section of the uterus in this case showed a myriad of vascular channels distributed throughout the myometrium and endometrium. In this case a uterine curettage could result in disastrous consequence. The uterine av fistulae may be congenital or may be acquired due to pelvic surgery, gestational trophoblastic neoplasia and postpartum status. Avms can happen anywhere, but they are more common. Arteriovenous malformation of the uterus is a rare uterine abnormality. Uterine arteriovenous malformation, images, and management. We present the case of a 54yearold woman with intermittent rightsided abdominal pain.
The tshaped malformation is commonly associated with inutero exposure the socalled desdaughters. Ultrasound diagnosis and management of acquired uterine. In the uterus, they may appear after curettage, cesarean delivery, and myomectomy among. Approximately 1 percent of women have uterine malformations. The condition can easily be confused with gestational trophoblastic disease. This case report describes a healthy 29yearold patient, nulligravida, with an unremarkable medical history, came from gynaecologist for ultrasaound due to complain of irregular heavy pv bleeding. Uterine arteriovenous malformation bmj case reports.
Uterine arteriovenous malformations avm are rare and can be classified as either congenital or acquired. Arteriovenous malformations are classified as congenital and acquired. Pregnancy following embolisation of uterine arteriovenous. Uterine arteriovenous malformation avm is a little known condition of which, to date, very few cases have been described. The bleeding caused by these malformations is episodic and can be torrential, warranting hospital admission and blood transfusions. Uterine av malformation and treatment related fertility. Successful treatment of uterine arteriovenous malformation. Arteriovenous malformation of the pregnant uterus is very rare, and may present with unexplained torrential bleeding. Thus, avoiding uae should be considered, particularly in women undergoing fertility treatments. The hormones of pregnancy and the menstrual cycle may play a role in the pathogenesis, as most patients present at a reproductive age. Diagnosis requires a high degree of suspicion and is done with ultrasound and doppler. Most are not inherited, with the exception of hereditary hemorrhagic telangiectasia hht.
Arteriovenous malformation, pregnant uterus introduction. Congenital malformations of uterus a condition is said to be a congenital anomaly when it affects a person from birth. Diagnosis of acquired uterine arteriovenous malformation by. Uterine arterial venous malformations avm are uncommon vascular lesions, but they may be a cause of potential lifethreatening genital. Uterine artery embolization for uterine arteriovenous.
Hysteroscopic management of uterine arteriovenous malformation. Uterine arteriovenous malformation avm is defined as abnormal and nonfunctional connections between the uterine arteries and veins. Such condition represents about 12% of all genital and intraperitoneal. They characteristically present with unexplained, intermittent and torrential bleeding. Arteriovenous malformation of the uterus associated with. As the name implies, this is an abnormal connection between the arterial and venous circulatory systems of the uterus. Congenital uterine anomalies impact reproductive and obstetric outcomes. Pdf uterine arteriovenous malformation researchgate. Oct 20, 2015 uterine arteriovenous malformations avms are rare. She was diagnosed with uterine avm, and was managed with uterine artery embolization followed by eventual hysterectomy. Uterine arteriovenous malformation with positive serum betahuman.
Congenital malformations of uterus laparoscopycures. However, only 25 percent of these patients present reproductive problems. Pdf uterine arteriovenous malformations uavm are a rare phenomenon, with very few reported cases. Congenital avms are extremely rare conditions, whereas the incidence rate of acquired avms is currently increasing 1. The bleeding is usually intermittent, torrential, or may be intractable and life threatening. Diagnosis and treatment of uterine and pelvic arteriovenous malformations. Three dimensional power doppler sonographic features of uterine vascular malformation. They are connected to each other, with no capillaries. Radiological findings of uterine arteriovenous malformation. Arteriovenous malformation, pregnant uterus introduction uterine arteriovenous malformation avm is extremely rare, with only less than 80 cases reported worldwide1. That interferes with the blood circulation in an organ. Congestive heart failure secondary to a vascular steal syndrome can be a less common clinical. Uterine arteriovenous malformations may cause lifethreatening abnormal genital bleeding in women at childbearing age.
Pelvic and uterine arteriovenous malformations avms can cause abnormal and potentially lifethreatening vaginal bleeding. Avm in the pelvis may be noted incidentally by computed tomography ct of the pelvis, and magnetic resonance imaging mri is frequently used to confirm and further characterize the sonographic findings of uterine avm. Uterine arteriovenous malformation avm is a rare disease and is usually an acquired disorder which can remain asymptomatic or cause lifethreatening bleeding. Spontaneous regression of uterine arteriovenous malformations. Location of this lesion in the uterine cervix is exceptional. Uterine arteriovenous malformations avms are a rare, potentially lifethreatening cause of abnormal uterine bleeding that can be acquired following uterine instrumentation. This entity is generally associated with the presence of molar disease, choriocarcinoma and uterine surgery, but may be congenitally acquired. Diagnosis and treatment of uterine and pelvic arteriovenous. Treatment recommendations include embolization versus hysterectomy. Acquired uterine arteriovenous malformation and retained. Poppe w, van assche f a, wilms g, favril a, baert a. They are usually acquired malformations that follow a pregnancy event and are diagnosed when uterine bleeding remains uncontrolled despite medical measures. This case demonstrates the congenital nature of abnormality.
Most of the women with uterine av malformation and fistulae present in the reproductive age group with abnormal, unexplained vaginal bleeding. The treatment of choice depends on the symptoms, age, desire for future fertility, and localization and size of. Arteriovenous malformation of the uterus associated with a. Uterine arteriovenous malformation radiology reference. Uterine arteriovenous malformation avm can cause massive hemorrhage and is often treated with uterine artery embolization uae, which may lead to ovarian insufficiency. We report a case of acquired uterine av malformation associated with retained products of conception.
Mr imaging showed a bulky uterus, a focal uterine mass, disruption of the junctional zones, serpiginous flowrelated signal. The incidence of uterine avms is unknown, but there have been less than 100 cases reported in the literature. We report a patient with absence of the conventional risk factors, and was saved by quick recourse to hysterectomy to control the bleeding. Figure 5 gray scale image of the arteriovenous malformation. The etiology of uterine avms is either congenital or acquired. A uterine malformation is a type of female genital tract malformation resulting from abnormal development of the mullerian ducts during embryogenesis preventing the formation of a normal uterus. Uterine arteriovenous malformations avm are a rare cause of obstetrical hemorrhage. Uterine arteriovenous malformation avm is a rare cause of heavy and sometimes lifethreatening vaginal bleeding. Vascular malformations as a cause of postpartum hemorrhage. Its treatment can vary from expectant management to hysterectomy. Your vascular system is your bodys network of blood vessels. Arteriovenous malformations avms are defects in your vascular system. Pregnancy following embolisation of uterine avmy n chia et al references 1.
Pregnancy after transcatheter embolisation of a uterine arteriovenous malformation. Contrast ct led to a strong suspicion of an arteriovenous malformation of the uterus. We report a rare case of arteriovenous malformation of the pregnant uterus. Acquired uterine arteriovenous malformations and placental ingrowth into the myometrium are increasingly reported after surgical uterine procedures. A uterine arteriovenous malformation avm is an uncommon cause of uterine bleeding. A uterine malformation is a type of female genital malformation resulting from an abnormal development of the mullerian ducts during embryogenesis. A malformation is an abnormal connection between the veins and arteries. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect. We present three women diagnosed with postmiscarriage avm on color doppler by transvaginal ultrasound imaging. After consideration of all treatment options, total laparoscopic hysterectomy was performed.
Uterine arteriovenous malformations and ultrasonography 177j. Uterine bleeding is the major presenting symptom in avms. Uterine arteriovenous malformations induced after diagnostic. Arteriovenous malformations avms are defects in the blood vessels of the circulatory system. Ultrasonography is a noninvasive diagnostic method able to demonstrate and characterize avms of the uterus. Arteriovenous malformation of the uterus bmj case reports. Acquired uterine arteriovenous malformation following. It has a very diverse symptomatology, even though in most cases, it is diagnosed during a severe and acute haemorrhagic event. Here we present a case of a large uterine avm accompa nied by positive serum betahuman chorionic gonadotropin. It is a potentially lifethreatening condition, as patients may present with profuse bleeding. It is a dilatation of the intervillous space deep inside the myometrium, allowing a direct flow from the arterial system towards the venous system, without participation of capillary vessels.
Ultrasound scans showed an unusual vascular appearance of the uterus with a thinned endometrium. Treatment of uterine avm is hysterectomy or less invasive fertility sparing procedure like uterine artery. This case report describes a 33yearold woman who presented with secondary postpartum hemorrhage. All of them were in the reproductive age group 2236 years. As these malformations are less common after menopause, postmenopausal bleeding is rarely seen. Acquired uterine arteriovenous malformation avm is a rare cause of postpartum vaginal bleeding, representing 1% to 2% of all genital and intraperitoneal hemorrhages, and as such should be considered in any postpartum female that presents complaining of vaginal bleeding, particularly if the patient has undergone instrumentation of the uterus 1. Uterine arteriovenous malformations uavm result from the formation of multiple arteriovenous fistulous communications within the uterus without an intervening capillary network.
Treatment can be surgical hysterectomy or surgical removal of avm, or with selective uterine arterial embolization. Jun 15, 2012 uterine arteriovenous malformation avm is a rare condition, with fewer than 100 cases reported in the literature. The tip of the catheter in a and b is in the tight internal iliac artery. January 2018 diagnosis and treatment of uterine and pelvic arteriovenous malformations. Pdf arteriovenous malformation in uterine cervix during.
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