Uterine arteriovenous malformation Acquired Dr Mamta Lekhi Sr Consultant Obstetrician and Gynaecologist MAMTA MEDICARE CENTRE East Delhi

1. Uterine arteriovenous
malformation
(Acquired)
Dr Mamta Lekhi
Sr Consultant Obstetrician and Gynaecologist
MAMTA MEDICARE CENTRE
East Delhi

2. Causes
• First reported 1982 - Forssmanet et al
• Secondary to
1. Dilatation and curettage
2. Caesarean section
3. Gestational trophoblastic disease
4. Uterine malignancies

3. • Trauma to endothelium during curettage
• Increased myometrial VEGF angiogenesis and
revascularisation have been noted after hysteroscopy for
Asherman`s.
• Biological aberration of the placental bed during
deplacentation
• Venous sinuses become incorporated within the
myometrium after necrosis of chorionic villi

4. CASE REPORT
• P1A2 with previous LSCS 6 years ago
• Previous history- medical abortion followed by D&C
• Present - failed medical abortion with retained pregnancy
• USG- 7 weeks IU pregnancy
• Severe chest infection

5. • Dilation , suction evacuation and curettage 15th march
• Preceded by Misoprost per vaginal and oxytocin in IV drip
• Under antibiotic cover
• Excess vascular arena observed
• Cavity felt empty
• Blood with ?conception product obtained and sent for
HPE

6. • HPE-
• Blood clots and fibrin
• Few chorionic villi
• partly degenerated
• Occasional decidua and neutrophilic infiltrates

7. USG
• Intensely vascular AV malformation with no
trophoblastic signals
Type to enter a caption.

9. • Beta HCG on 1month follow up
• Shows declining trend from 81.3 to 5.77
• PSTT has to be ruled out.
• Advised UA embolisation in view of extensive
malformation
• Delayed
• Massive bleed after a few days

10. MR imaging after bleeding
controlled
Increased T2 signal

11. Managed by UAE
• Under fluoroscopic guidance
• Right femoral artery access
• Bilateral uterine arteries selectively catheterised
• Contrast showed dilated and tortuous uterine arteries
suggestive of AVM
• 4ml 30% glue and 1.3ml 40 % glue

12. • Post UAE check ultrasound
• Echogenic focus seen in uterus- glue cast
• No residual nidus seen

14. • Lesion shown on colour doppler

22. Conclusion
1. AVM can lead to massive HMB
2. More number of cases need to be studied
3. Treatment modalities are
A. spontaneous resolution
B.Medical- GnRH, OCP , Methyl ergometrine
C.UAE
D.Hysterectomy in some cases

23. Thank you