Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth
Uterine arteriovenous malformations (UAVMs) that occur after birth are a rare cause of late postpartum hemorrhage. Acquired UAVMs usually occur in conjunction with pathology of the placenta. In the spectrum of placenta accreta (PAS), subinvolution of the placental bed plays an important role in its...
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2024-11-01
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| author | Constantin-Cristian Vaduva Laurentiu Dira Sidonia Maria Sandulescu Cristian Constantin Elena Silvia Bernad Dana Maria Albulescu Mircea-Sebastian Serbanescu Lidia Boldeanu |
| author_facet | Constantin-Cristian Vaduva Laurentiu Dira Sidonia Maria Sandulescu Cristian Constantin Elena Silvia Bernad Dana Maria Albulescu Mircea-Sebastian Serbanescu Lidia Boldeanu |
| author_sort | Constantin-Cristian Vaduva |
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| description | Uterine arteriovenous malformations (UAVMs) that occur after birth are a rare cause of late postpartum hemorrhage. Acquired UAVMs usually occur in conjunction with pathology of the placenta. In the spectrum of placenta accreta (PAS), subinvolution of the placental bed plays an important role in its pathophysiology. We present a case of UAVM in a pregnant woman with PAS who presented with marked metrorrhagia after delivery, which was treated with classical management. Then, 35 days later, she presented to the emergency room with severe metrorrhagia. As it was suspected that she had placental remnants, an instrumental uterine control was performed, but the bleeding persisted, requiring further uterine packing and blood administration. Later, uterine artery embolization was performed with good results. Color Doppler ultrasound, magnetic resonance imaging, and angiography were the methods with the greatest diagnostic value. The differential diagnosis was as complex as the treatment. We hypothesize that UAVM may develop from minimal residual PAS in this late postpartum period. Moreover, they may recover rapidly after local surgical ablation. Considering the clinical condition, hemodynamic status, and desire to preserve fertility, we were able to avoid a hysterectomy, which is often chosen in such cases of severe, life-threatening bleeding complications. |
| format | Article |
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| institution | OA Journals |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-11-01 |
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| spelling | doaj-art-01d7657fedf446e5b3f0ea4c1715bbcc2025-08-20T02:08:09ZengMDPI AGDiagnostics2075-44182024-11-011422253810.3390/diagnostics14222538Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After BirthConstantin-Cristian Vaduva0Laurentiu Dira1Sidonia Maria Sandulescu2Cristian Constantin3Elena Silvia Bernad4Dana Maria Albulescu5Mircea-Sebastian Serbanescu6Lidia Boldeanu7Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, University of Medicine and Pharmacy, 200143 Craiova, RomaniaDepartment of Obstetrics and Gynecology, Filantropia Clinical Hospital, University of Medicine and Pharmacy, 200143 Craiova, RomaniaDepartment of Obstetrics and Gynecology, Filantropia Clinical Hospital, University of Medicine and Pharmacy, 200143 Craiova, RomaniaDepartment of Radiology, County Clinical Emergency Hospital, University of Medicine and Pharmacy, 200642 Craiova, RomaniaDepartment of Obstetrics and Gynecology, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, RomaniaDepartment of Anatomy, University of Medicine and Pharmacy, 200349 Craiova, RomaniaDepartment of Pathology, Filantropia Clinical Hospital, University of Medicine and Pharmacy of Craiova, 200143 Craiova, RomaniaDepartment of Microbiology, County Clinical Emergency Hospital, University of Medicine and Pharmacy, 200642 Craiova, RomaniaUterine arteriovenous malformations (UAVMs) that occur after birth are a rare cause of late postpartum hemorrhage. Acquired UAVMs usually occur in conjunction with pathology of the placenta. In the spectrum of placenta accreta (PAS), subinvolution of the placental bed plays an important role in its pathophysiology. We present a case of UAVM in a pregnant woman with PAS who presented with marked metrorrhagia after delivery, which was treated with classical management. Then, 35 days later, she presented to the emergency room with severe metrorrhagia. As it was suspected that she had placental remnants, an instrumental uterine control was performed, but the bleeding persisted, requiring further uterine packing and blood administration. Later, uterine artery embolization was performed with good results. Color Doppler ultrasound, magnetic resonance imaging, and angiography were the methods with the greatest diagnostic value. The differential diagnosis was as complex as the treatment. We hypothesize that UAVM may develop from minimal residual PAS in this late postpartum period. Moreover, they may recover rapidly after local surgical ablation. Considering the clinical condition, hemodynamic status, and desire to preserve fertility, we were able to avoid a hysterectomy, which is often chosen in such cases of severe, life-threatening bleeding complications.https://www.mdpi.com/2075-4418/14/22/2538uterine arteriovenous malformation (UAVM)placenta accreta spectrum (PAS)color Doppler ultrasound (CDUS)uterine artery embolization (UAE)postpartum hemorrhage (PPH)case report |
| spellingShingle | Constantin-Cristian Vaduva Laurentiu Dira Sidonia Maria Sandulescu Cristian Constantin Elena Silvia Bernad Dana Maria Albulescu Mircea-Sebastian Serbanescu Lidia Boldeanu Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth Diagnostics uterine arteriovenous malformation (UAVM) placenta accreta spectrum (PAS) color Doppler ultrasound (CDUS) uterine artery embolization (UAE) postpartum hemorrhage (PPH) case report |
| title | Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth |
| title_full | Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth |
| title_fullStr | Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth |
| title_full_unstemmed | Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth |
| title_short | Case Report of Placenta Accreta Spectrum and Arteriovenous Malformations with Successful Preservation of Fertility After Birth |
| title_sort | case report of placenta accreta spectrum and arteriovenous malformations with successful preservation of fertility after birth |
| topic | uterine arteriovenous malformation (UAVM) placenta accreta spectrum (PAS) color Doppler ultrasound (CDUS) uterine artery embolization (UAE) postpartum hemorrhage (PPH) case report |
| url | https://www.mdpi.com/2075-4418/14/22/2538 |
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