Two cases of uterine vascular malformations diagnosed by color doppler ultrasound and managed conservatively by uterine artery embolization / Philippine Journal of Obstetrics and Gynecology

@#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.

An uncommon cause of postpartum hemorrhage after cesarean section treated with selective arterial embolization: Pseudoaneurysm of the uterine pedicle / 대한산부인과학회잡지

This is a very important differential diagnosis for postpartum hemorrhage following cesarean delivery because repeated life-threatening bleeding may induce multiple blood transfusion and require emergency surgery including hysterotomy. False or pseudoanuerysm can be acquired in association with trauma, previous surgery, trophoblastic disease, neoplasm, infection or diethylstilbestrol exposure. When a punctured or lacerated artery does not seal completely, blood may escape and dissects the adjacent tissues, and collects in perivascular areas. If this collection maintains in communication with the parent vessel, a pseudoaneurysm could result. Typically the lesion are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage. Radiographic techniques (angiography, ultrasound, and magnetic resonance imaging) have provided the opportunity to diagnose pseudoaneurysm, arteriovenous malformation. We report a case of postpartum hemorrhage following cesarean delivery attributed to a pseudoaneurysm of the uterine pedicle and treated with arterial embolization. Angiographic study confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the hemorrhage.