December 19th, 2014

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Title:
Conservative Management of Cesarean Scar Pregnancy with Uterine Arteriovenous Malformation: A Case Report
Authors:  Puneet Kaur Kochhar, M.D., D.N.B., MRCOG, Monica Sarangal, D.G.O., and Usha Gupta, M.D.
 
BACKGROUND: Cesarean scar pregnancy is a rare type of ectopic pregnancy in which implantation occurs in a previous lower segment cesarean scar. It may be associated with uncontrolled hemorrhage ending in hysterectomy. It can become potentially life threatening for the patient when it further gets complicated by uterine arteriovenous malformation (AVM). To the best of our knowledge there are only a few previous reports of AVM complicating a scar pregnancy. It is still unclear which treatment is most optimal.

CASE: We describe a case of a scar pregnancy complicated by uterine AVM. The diagnosis was made using 3D color Doppler ultrasound, showing a highly vascular tumor in the isthmic region of the uterus. Computed tomography angiography supported the diagnosis. The patient underwent selective embolization of the uterine artery followed by weekly intramuscular injections of methotrexate. Recovery was uneventful.

CONCLUSION: The decision regarding mode of treatment should be made by the patient and the clinician based on the local expertise and experience. Judicious use of medical management (methotrexate) and uterine artery embolization may prevent hysterectomy and allow preservation of fertility.
Keywords:  arteriovenous malformations, cesarean section, ectopic pregnancy, methotrexate, uterine artery embolization
   
   
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