Uterine arteriovenous malformation secondary to cesarean scar ectopic pregnancy: a rare case report from Nepal.

INTRODUCTION

Uterine arteriovenous malformations are abnormal vascular connections between uterine veins and arteries, bypassing the capillary network. Cesarean scar ectopic is a rare cause of acquired uterine arteriovenous malformation, with only a few cases described in the literature.

CASE PRESENTATION: A 30-year Gravida 3 Para 2 Living 1 female presented with amenorrhea for 2.5 months and intermittent vaginal bleeding with passage of clots for 3 weeks. She was hemodynamically stable at the time of examination, with per speculum examination revealing active bleeding. Transvaginal sonography revealed a scar ectopic at the previous caesarean scar, and she was given methotrexate for medical management. The bleeding did not control, warranting further investigations with Doppler ultrasonography (USG) and a computed tomography angiography scan, revealing a uterine arteriovenous malformation. Then, uterine artery embolization was done, following which surgery was done due to persistent vascularity.

DISCUSSION: Per vaginal bleeding in young women may be caused by scar ectopic and uterine arteriovenous malformations. Doppler USG is the first-line investigation, and computed tomography scan and magnetic resonance imaging help in confirming the diagnosis. Methotrexate, along with uterine artery embolization, is used in the treatment. Surgery is required if persistent bleeding occurs.

CONCLUSION

Cesarean scar ectopic can be a cause of acquired uterine arteriovenous malformation, and early diagnosis and treatment should be done to prevent complications.