Uterine Arteriovenous Malformation: Approach and Treatment in a Nulligravidous Virgin Woman

Introduction

•       Uterine arteriovenous malformation (UAVM) is a rare and potentially life-threatening condition characterized by abnormal connections between uterine arteries and veins.

•       To our knowledge, this is the first reported case of UAVM in a nulliparous, virgin patient presenting with profuse vaginal bleeding.

Objectives

•       Contribute to the limited literature on UAVM in unique patient populations.

•       Discuss treatment approaches with a focus on fertility preservation.

Clinical case

Patient Profile and Presentation:

•       A 20-year-old woman presented with heavy vaginal bleeding.

•       She had a history of a similar episode requiring blood transfusion and an anaphylactic reaction to tranexamic acid.

Clinical Course:

•        Lost 3 liters of blood managed with blood product replacement.

•        Patient stabilized with spontaneous cessation of bleeding.

Diagnostic Findings:

•        MRI identified a mass-like lesion and abnormal serpentine vessels, suggestive of UAVM.

•        Doppler ultrasound: multiple feeding arteries and draining veins, with low RI and high PSV flow.

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 Management:

•        She requested a fertility-sparing option and refused all vaginal approaches.

•        Offered hysteroscopic resection but declined and underwent UAE with bilateral uterine artery embolization.

Outcome:

•       Two months: MRI showed thrombosed UAVM with minimal persistent activity.

•        Three months: FSH and AMH within normal levels.

•        One-year: The patient reported no complains and normal menstrual flow.

Conclusion

•       UAE is an effective treatment option for UAVM. Further studies are needed to compare the efficiency of UAE and hysteroscopic resection.

•       Despite multiple life-threatening bleeding events, the patient refused vaginal approaches due to cultural concerns, further studies are needed to investigate this in the middle east.