Arteriovenous malformation in a bicornuate uterus leading to recurrent severe uterine bleeding: a case report

BACKGROUND: Uterine arteriovenous malformations (AVMs) are rare entities that have been documented in a wide age range. Several treatment modalities have been highlighted in the literature. Uterine artery embolization appears to be effective therapy for select cases. Embolization provides an alternative to hysterectomy and the potential for future fertility. To our knowledge, only 1 other case report describes an AVM existing within a bicornuate uterus. CASE: A 31-year-old, married, Caucasian woman with a history of infertility presented with intermittent uterine hemorrhage resulting in symptomatic anemia. The patient was diagnosed with a uterine AVM existing within the left horn of a bicornuate uterus. The patient underwent uterine artery embolization, with resolution of the vascular mass and resumption of regular menstrual flow. CONCLUSION: AVM in a bicornuate uterus is rarely reported. Selective uterine artery embolization offers an effective modality of treatment.     

Juvenile cystic adenomyosis mimicking uterine malformation: a case report

Cystic adenomyosis is a rare form of adenomyosis mostly seen in middle aged women. We report a case of cystic adenomyosis in a juvenile patient presenting with severe dysmenorrhea refractory to any given medication. The patient initially was diagnosed as uterus bicornis with an obstructed rudimentary horn. Surgical exploration and excision of the cystic mass relieved the symptoms of the patient.     

Pregnancy after medical management of a uterine arteriovenous malformation. A case report

BACKGROUND: The natural history of conservatively managed uterine arteriovenous malformations is largely unknown, and the risks associated with subsequent pregnancy and vaginal delivery have not been established. CASE: A multiparous woman with a previously reported history of uterine arteriovenous malformation was monitored throughout pregnancy and vaginal delivery. Serial ultrasound studies were performed prior to a successful induction of labor for severe preeclampsia at 34 weeks' gestation. CONCLUSION: To our knowledge, this is the first report of pregnancy and vaginal delivery in a woman with a prior history of a medically managed uterine arteriovenous malformation. Noninvasive treatment of uterine arteriovenous malformations is rare, and the potential long-term risks of this approach, including pregnancy, remain uncertain.     

Late postpartum eclampsia: report of two cases managed by uterine curettage and review of the literature

The purpose of this study was describe two patients with rapid recovery of refractory late postpartum eclampsia (LPPE) following uterine curettage, and to evaluate the literature about supportive evidence for such a management in LPPE. A detailed literature search was performed focusing on studies reporting the clinical presentation, laboratory workup, imaging, and management of LPPE. Mean reported onset of LPPE was on postpartum day 7.0 +/- 2.9. Only 35.3% had a history of preeclampsia: these had earlier onset of seizures compared with the subjects without history of preeclampsia (4.3 +/- 1.4 versus 7.6 +/- 2.9 days; p < 0.005). Onset of seizure was correlated with systolic blood pressure (Pearson's r = 0.34; p < 0.05). Major associated symptoms were headaches (71.4%), visual changes (46.0%), and nausea/vomiting (22.2%); 67.5% of patients were proteinuric. The remaining laboratory tests were usually normal. Among the patients with a normal head computed tomography, magnetic resonance imaging identified additional abnormalities in 53.8% (seven of 13). A total of 69.7% of patients developed multiple seizure episodes, some of these occurred while the patient was receiving magnesium sulfate treatment; 82.5% of patients underwent magnesium therapy and approximately half of those patients required multiple antiseizure drugs. The number of seizures was only correlated with the diastolic blood pressure (Pearson's r = 0.52; p < 0.01). Even remote from delivery, headaches, visual change, and nausea/vomiting are important symptoms of LPPE. Hypertension and/or proteinuria are important diagnostic findings. LPPE is often characterized by refractory seizures and controlling the diastolic blood pressure is important. Patients presented in our case report showed no seizures after uterine curettage. This potential useful management for LPPE requires additional investigation.     

Arteriovenous malformation identification after conservative management of placenta percreta with uterine artery embolization and adjunctive therapy

Placenta percreta is a complication of pregnancy with significant morbidity and mortality rates. Conservative management may be considered when fertility preservation is desired or to possibly reduce morbidity when there is invasion of pelvic structures. We present 3 cases of antenatally diagnosed placenta percreta that were managed conservatively. A finding after the operation included the identification of arteriovenous malformations.     

Transcatheter embolization of uterine arteriovenous malformation: report of 2 cases and review of literature

Arteriovenous malformation (AVM) of the uterus is a rare cause of menorrhagia and may at times lead to life-threatening hemorrhage. The clinical findings may not always be reliable in the diagnosis of uterine AVM, and a high index of suspicion is important because, unlike many other causes of menorrhagia, curettage may paradoxically aggravate the bleeding. Herein are described the cases of 2 patients with uterine AVM with abnormal vaginal bleeding. Both had a history of abortion followed by dilation and curettage. In both patients, the diagnosis of uterine AVM was established at Doppler flow ultrasonography. Treatment using transcatheter embolization was successful, and both patients had normal menstrual cycles at follow-up. One patient delivered a healthy baby 2? years after transcatheter embolization.     

Pregnancy complicated by asymptomatic uterine arteriovenous malformation: a case report

BACKGROUND: Uterine arteriovenous malformation (AVM) is a rare disease. Percutaneous arterial embolization has been performed for patients who wish to preserve their ability to conceive. CASE: A 27-year-old primigravida was admitted for treatment of threatened premature labor at 21 weeks of gestation. She had been diagnosed with asymptomatic uterine AVM 2 years previously. She had not received any treatment before conception. At 41 weeks of gestation she spontaneously delivered a healthy infant weighting 3,154 g. and the Excessive bleeding (1,600 mL) occurred, probably due to eruption of the AVM vessel at the time of parturition. At 3 months postpartum, the patient underwent arterial embolization of AVM. CONCLUSION: The management of uterine AVM should be individualized, taking into account the patient's desire to maintain her fertility and the symptoms.     

Ectopic pregnancy after successful treatment with percutaneous transcatheter uterine arterial embolization for congenital uterine arteriovenous malformation: a case report

INTRODUCTION: Uterine arteriovenous malformation (AVM) is a rare disease. Percutaneous transcatheter uterine arterial embolization (UAE) has been performed in patients who wish to preserve their ability to conceive. UAE is considered to be a safe and effective procedure, but its long-term effect on fertility has not been fully elucidated. We present a case of ectopic tubal pregnancy after conservative treatment with UAE for uterine AVM. CASE: A 30-year-old Japanese woman was admitted for the treatment of unruptured right tubal pregnancy at 6 weeks of gestation. She had conceived spontaneously and delivered a healthy baby at term, 3 years previously. Subsequently, she was successfully treated with UAE for a large congenital uterine AVM. Transvaginal color Doppler ultrasonography revealed no evidence of residual AVM vessels. After the diagnosis of ectopic pregnancy, the patient underwent right tubectomy. At laparotomy, there were no adhesions or structural anomalies in the pelvic cavity that might affect tubal function. The patient's postoperative course was uneventful, and she is now healthy without conception 24 months after surgery. CONCLUSION: Prior uterine arterial embolization may have affected the tubal function in the present case, allowing tubal pregnancy to occur.     

Pregnancy after embolization of uterine myoma: report of 12 cases

Objective: To treat uterine myomas with embolization, to look for pregnancy-induced myoma recurrences, and to assess pregnancy course and outcome after embolization.

Design: Observational clinical study.

Setting: University of Paris VII hospital.

Patient(s): Nine women had embolization for symptomatic myoma, with 12 pregnancies observed.

Intervention(s): Embolizations were highly selective and performed bilaterally through the uterine arteries with polyvinyl alcohol.

Main Outcome Measure(s): Pregnant women were evaluated by physical and sonographic examinations.

Result(s): Before embolization, the mean uterine volume was 450 cm³, and in six patients polymyomas were present. The median age at embolization was 40 years; the median delay before pregnancy was 9 months; and the median age at first pregnancy outcome was 41 years. Five early miscarriages occurred. The seven other pregnancies were uneventful, although three premature births and one case of late toxemia occurred unrelated to previous embolization. Three women delivered vaginally and four by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed.

Conclusion(s): The results of this first series of 12 pregnancies after myoma embolization are promising. If these preliminary results are confirmed, embolization could be a major breakthrough in the management of myoma and could replace conventional medical and surgical treatments.     

Pregnancy after transcatheter embolization of a uterine arteriovenous malformation

A 25-year-old woman with a congenital uterine arteriovenous malformation had a long history of repeated excessive vaginal bleeding. She was successfully treated with transarterial embolization. She had normal menstrual periods for 6 months and subsequently conceived. She was delivered of a normally grown baby at 35 weeks. To the best of our knowledge, this is the third pregnancy described after successful embolization of an arteriovenous malformation.     

Acute uterine inversion: a report of two cases

Acute inversion of the uterus is a serious but rare complication of the third stage of labor. The exact frequency of the complication is not known. Two cases seen and managed in the Obstetric Department of a district hospital are reported. The literature on this subject is reviewed; the possible causative factors and management techniques are discussed.     

Puerperal uterine inversion: a report of four cases

Acute puerperal uterine inversion is a life-threatening and unpredictable obstetric emergency. If overlooked, it could lead to a maternal death. Although the precise cause is unknown, it is postulated to be caused by the mismanagement of the third stage of labor with premature traction of the umbilical cord and fundal pressure before placental separation. At the Ipoh General Hospital in Malaysia there were 31 394 deliveries and four acute uterine inversions occurring from 1 January 2002 to 30 June 2005. The four patients were between 25 and 36 years of age and their parities were between two and three. When manual repositioning of the uterus failed, successful correction was accomplished by the O'Sullivan's hydrostatic method. One case had to undergo subtotal hysterectomy after repositioning because of massive hemorrhage secondary to placenta accreta. Early diagnosis, immediate treatment of shock, and replacement are essential.     

Conservative management of large uterine arteriovenous malformation: case report

Uterine arteriovenous malformation is a rare condition that may be associated with uterine bleeding. Eventually morphologic aspects of the lesions induce unnecessary aggressive surgery; we report here a case of successful expectant management.     

Late hemorrhage after transcervical division of a uterine septum: a report of two cases.

The transcervical division of uterine septa is usually described as a simple procedure associated with minimal morbidity. Two cases are presented describing late hemorrhage after this procedure. Approaches to avoiding this complication as well as management principles are described.     

Pregnancy after uterine rupture: a report of 5 cases and a review of the literature

Management and outcome of 5 cases of pregnancy after uterine rupture are discussed. All women in these cases were delivered by cesarean delivery and no repeat ruptures occurred. After reviewing the literature, it is concluded that women with a previous uterine rupture have a favorable outcome in a subsequent pregnancy. With a rupture in a lower segment scar, an elective cesarean delivery should be performed before labor starts after assessing fetal lung maturity or administration of corticosteroids. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the risk associated with a subsequent pregnancy after a previous uterine rupture, summarize the complications of uterine rupture during a subsequent pregnancy, and to list the treatment plans for a patient in a subsequent pregnancy after uterine rupture.     

Treating a recurrent uterine arteriovenous malformation with uterine artery embolization. A case report

BACKGROUND: Uterine arteriovenous malformation is a rare condition. Uterine artery embolization offers the possibility of conservative management as opposed to the traditional hysterectomy. We report a case with recurrent uterine arteriovenous malformation confirmed by angiography and successfully treated with a second embolization procedure. CASE: A 33-year-old woman presented with heavy vaginal bleeding. The diagnosis of uterine arteriovenous malformation was suspected on Doppler ultrasonography and confirmed by angiography. The first embolization procedure was performed using polyvinyl alcohol and steel coils. Recurrence was diagnosed 1 year later with the same imaging techniques. The second embolization procedure was performed using histoacryl. The patient remained asymptomatic at 1-year of follow-up. CONCLUSION: Minimally invasive management is an option in recurrent uterine arteriovenous malformation.     

Pregnancy outcome after laparoscopic cryomyolysis of uterine myomas: report of nine cases

STUDY OBJECTIVE: To assess pregnancy course and outcome after laparoscopic cryomyolysis. DESIGN: Open, one-arm, observational clinical pilot study. (Canadian Task Force classification II). SETTING: University-affiliated public hospital. PATIENTS: Nine women who underwent laparoscopic cryomyolysis, with nine pregnancies observed. INTERVENTION: Laparoscopic cryomyolysis was performed by penetrating along the long axis of the myoma and provoking freezing at temperature -197 degrees C. MEASUREMENTS AND MAIN RESULTS: After laparoscopic-directed cryomyolysis, pregnant women were evaluated by physical and ultrasonographics examinations. The median time elapsed between cryomyolysis and pregnancy was 14 months (range 7-39 months). At the beginning of pregnancy, the mean volume of myomas was 30.4 mL (range 1.8-124.6 mL). During the first 20 gestational weeks, the mean increase in volume of the nine cryo-treated myomas was 71.1% (range 21.8%-97.7%); the volume of two myomas remained stationary, and two new myomas appeared. Two patients had early miscarriage. Seven pregnancies had a regular course. Four women delivered vaginally, and three by cesarean section. There were no complications in pregnancy, postpartum, and puerperium. No cases of uterine rupture were observed. CONCLUSIONS: The results of this series of nine pregnancies after laparoscopic cryomyolysis are promising. Laparoscopic cryomyolysis does not compromise a good pregnancy outcome and vaginal delivery. These preliminary data need to be confirmed by larger studies.