January 17th, 2021

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Healthy Term Live Birth After Focal Embolization of Symptomatic Post-Myomectomy Arteriovenous Malformation in a Patient with Recurrent Pregnancy Loss: A Case Report
Authors:  Abigail Armstrong, M.D., and Lindsay Kroener, M.D.
BACKGROUND: Arteriovenous malformations (AVMs) are vascular tangles of arteries and veins without intervening capillaries, leading to unstable, high-flow vessels. Uterine AVMs are rare and typically develop secondary to uterine trauma. The most common current treatment, although controversial, is uterine artery embolization, which allows for uterine preservation for women desiring fertility.

CASE: A 36-year-old G2P0020 woman had a history of recurrent pregnancy loss and abdominal myomectomy. She developed post-hysterosalpingogram bleeding and was found to have a uterine AVM. She underwent a focal interventional radiology–guided uterine artery embolization. She spontaneously conceived 9 months post-embolization and delivered a healthy infant at term.

CONCLUSION: We describe the case of a 36-year-old woman with recurrent pregnancy loss and a history of abdominal myomectomy who developed hemorrhage after a hysterosalpingogram, leading to the diagnosis of a postsurgical arteriovenous malformation (AVM). She was treated with focal embolization of her uterine AVM. She became pregnant spontaneously 9 months after treatment and delivered a healthy infant at term. This case provides information on a rare cause of AVM and subsequent management with focal uterine artery embolization in a premenopausal woman desiring fertility.
Keywords:  abortion, recurrent; arteriovenous malformations; fertility preservation; pregnancy outcome; ultrasonography; uterine artery embolization; uterine hemorrhage; uterus
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