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Two cases of uterine vascular malformations diagnosed by color doppler ultrasound and managed conservatively by uterine artery embolization

Mary Ann C. Delena, MD, FPOGS and Rosa Nierva-Velante, MD, FPOGS, FPSMFM, FPSUOG
Department of Obstetrics and Gynecology, St. Luke’s Medical Center, Quezon City

Vascular malformations of the uterus are rare, but could be a cause of life-threatening profuse abnormal uterine bleeding. Most reported cases in the literature are the arteriovenous malformations (AVM’s), arterio-venous (AV) fistulas or pseudoaneurysms. The true incidence is not yet known though they represent about 1-2% of all the genital and intraperitoneal hemorrhages.

AVM is an abnormal connection between uterine arteries and veins while pseudoaneurysm or false aneurysm is an extraluminal collection of blood with turbulent flow that communicates with the parent vessel through a defect in the arterial wall. Both conditions could cause profuse or torrential abnormal uterine bleeding after uterine surgery, manipulation, or cesarean section or any procedures that could cause injury to the uterus. Treatment options or modalities are similar for both. The treatment of choice whether conservatively or surgically depends on the symptoms, age, desire for future fertility, location and size of the lesion. Pelvic angiography is the gold standard diagnostic modality, though transvaginal ultrasound with color Doppler provides a valuable, non- invasive and readily accessible initial diagnostic procedure. Uterine artery embolization is the treatment of choice in symptomatic patients desirous of future fertility. We report a case of AVM after dilatation and curettage (D&C) for missed abortion and pseodoaneurysm after cesarean section(CS) which were initially diagnosed with transvaginal color Doppler ultrasound – as vascular malformation (AVM versus AV-fistula vs. Pseudoaneurysm), prior to angiography and successfully treated by uterine artery embolization.