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Ginecología y obstetricia de México
Print version ISSN 0300-9041
Abstract
FERNANDEZ CONDE, Cristina; GARCIA JIMENEZ, Rocío; VALERO, Irene and ARIZA ESTEPA, Esperanza Macarena. Uterine arteriovenous malformation as a cause of late puerperal hemorrhage. Ginecol. obstet. Méx. [online]. 2023, vol.91, n.8, pp.631-636. Epub Nov 17, 2023. ISSN 0300-9041. https://doi.org/10.24245/gom.v91i8.8085.
BACKGROUND:
Uterine arteriovenous malformations are a rare cause of puerperal hemorrhage, with only 150 cases reported in the literature. Their knowledge is important because they are life-threatening and because there has been an increase in recent years. They are usually related to interventions in the uterus: curettage, caesarean section or myomectomy or associated with neoplasms (gestational trophoblastic disease or endometrial adenocarcinoma), although others are congenital.
CLINICAL CASE:
A 32-year-old patient with a cervical conization and ablation of a uterine myoma by radiofrequency as the only history of interest. Fifteen days after a euthecological delivery, which was the first in her history, she had an episode of abundant metrorrhagia. In the immediate postpartum period, she had a heavy hemorrhage that required the transfusion of two red blood cell concentrates. Transvaginal ultrasound showed a uterus measuring 22 x 44 mm, which could correspond to a retained cotyledon. In view of the persistent bleeding, intracavitary tamponade was placed with a Foley catheter, which led to cessation of bleeding. After ruling out embolization of the uterine arteries due to the large size of the arteriovenous malformation, a simple total hysterectomy by laparotomy was performed.
CONCLUSION:
Uterine arteriovenous malformations, although an infrequent cause of puerperal hemorrhage, should be suspected because they are potentially fatal.
Keywords : Uterine arteriovenous malformation; Puerperal hemorrhage; Uterine artery embolization; Hysterectomy.