Title : Vascular enigma: Uterine arteriovenous malformation linked to previous pregnancy
Abstract:
Introduction: Uterine arteriovenous malformation (AVM) is a rare but potentially life-threatening cause of abnormal uterine bleeding in women of reproductive age. Frequently acquired after pregnancy or uterine instrumentation, AVM should be considered in cases of unexplained heavy or prolonged bleeding to avoid morbidity from delayed diagnosis.
Case: This case series reports three cases of young, parous Filipino women in their 30s presenting with irregular or heavy vaginal bleeding. All had prior pregnancies; two had undergone cesarean sections and one had previous curettage. Transvaginal ultrasound with color Doppler revealed increased myometrial vascularity and turbulent, multidirectional flow. Magnetic resonance imaging and angiography confirmed the presence of uterine AVMs. All patients underwent uterine artery embolization. One patient required subsequent hysterectomy due to persistent bleeding, while the others showed significant resolution of vascularity and improvement of symptoms on follow-up imaging.
Discussion: Acquired uterine AVM is commonly linked to previous pregnancy or uterine trauma, with abnormal vascular connections forming within the myometrium. Doppler ultrasound serves as a valuable first-line diagnostic tool, with MRI and angiography providing confirmation and anatomical detail. Management depends on hemodynamic stability and reproductive goals.
Uterine artery embolization offers a minimally invasive, fertility-preserving option with high success rates, while hysterectomy remains the definitive treatment for refractory cases or those not desiring future fertility. Awareness of this condition is critical to prevent inappropriate interventions, such as curettage, that can worsen bleeding and increase morbidity.
Keywords: Abnormal uterine bleeding, uterine arteriovenous malformation, uterine artery embolization, hysterectomy
