Hysteroscopic diagnosis and successful management of an acquired uterine arteriovenous malformation by percutaneous embolotherapy
A 36-year-old lady, P2L2 (Para 2, living 2) underwent medical termination of pregnancy one month ago outside for failure of contraception. This was followed by laparoscopic tubal ligation in the same sitting. Subsequently she had profuse bleeding requiring blood transfusion after 15 days. She was admitted at our hospital with heavy bleeding. On admission, she was pale, pulse was 110/min, B.P. was 100/70 mm Hg and vaginal examination revealed a bulky soft uterus with open os and clots in the vagina. A transvaginal ultrasound showed parenchymal inhomogeneity in the uterus in the anterior wall with several interspersed sonolucent spaces of varying size []. The vascularity of uterus was increased on color Doppler []. Her CBC showed a Hb of 7 gm%, serum beta HCG was 50 IU/ml. A provisional diagnosis of uterine arteriovenous malformation or organized retained products of conception was made and hysteroscopy proceed was planned.\nHysteroscopy revealed a clot in the uterine cavity. There was a pulsatile bluish vascular mass in the fundus extending to anterior wall of uterus. A diagnosis of acquired arteriovenous malformation was made []. MR angiography confirmed an arteriovenous malformation at the fundus and anterior wall of uterus being fed by mainly by left uterine artery []. Patient was taken for percutaneous arterial embolization and bilateral uterine artery embolization was done with polyvinyl alcohol particles. Patient had cessation of bleeding after the embolization and she resumed menstrual cycle 5 weeks after the procedure with scanty menstrual flow. Transvaginal scan revealed reduced vascularity with embolic particles seen in uterine myometrium [].\nSix months later, patient continues to have cyclic menstrual bleeding with moderate flow.