Kemal Harzif Achmad, Rei O G, Haloho Agrifa, Silvia Melisa, Pratama Gita, Purwosunu Yuditiya, Wibawa Aria, Sidipratomo Prijo, Pandelaki Jacub
Division of Immuno-Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.
Int J Reprod Biomed. 2019 Mar 19;17(2):135-42. doi: 10.18502/ijrm.v17i2.3991. eCollection 2019 Feb.
Acquired uterine arteriovenous malformation (AVM) is a rare condition due to traumatic episodes in cesarean section. The patient can suffer from life-threatening hemorrhage or recurrent vaginal bleeding. Establishing this diagnosis is difficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of the cases were found with history of massive bleeding and diagnosed lately after recurrent bleeding history. Even though promising, one of our cases failed to be managed with TAE. It is important to diagnose early symptoms of AVM in order to prevent the life threatening event.
In these case series, four cases of AVMs after cesarean procedures will be reviewed. One could be diagnosed in less than a month but the other three took several months. The symptom of vaginal bleeding might occur a few weeks after the procedure is done, and most patients need transfusion and hospitalization. Three out of four patients were initially sent to the hospital in order to recover from shock condition, and one patient was sent for a diagnostic procedure. AVMs diagnostic was established with ultrasound with or without angiography. Three of our cases were succeeded by performing TAE procedure without further severe vaginal bleeding. One case failed to be treated with embolization and had to proceed with hysterectomy.
AVM should be considered early-on in patient with abnormal uterine bleeding and history of cesarean section. Embolization is still the first-choice treatment of AVMs, otherwise definitive treatment is hysterectomy in a patient without fertility need, or impossible to perform TAE.
获得性子宫动静脉畸形（AVM）是剖宫产创伤性事件导致的一种罕见病症。患者可能会遭受危及生命的出血或反复阴道出血。确立这种诊断很困难，常因信息不足和病例数量少而被误诊。经动脉栓塞（TAE）手术在我们中心很少进行。所有病例均有大量出血史，且在反复出血后才得以确诊。尽管TAE有前景，但我们的一个病例未能通过TAE成功治疗。早期诊断AVM的症状对于预防危及生命的事件很重要。
在这些病例系列中，将回顾4例剖宫产术后的AVM病例。1例在不到1个月内确诊，但其他3例则花费了数月时间。阴道出血症状可能在手术后几周出现，大多数患者需要输血和住院治疗。4例患者中有3例最初因休克状态被送往医院，1例患者被送去进行诊断性检查。通过超声检查（有或无血管造影）确立了AVM的诊断。我们的3例病例通过TAE手术成功治疗，未再发生严重阴道出血。1例栓塞治疗失败，不得不进行子宫切除术。
对于有子宫异常出血和剖宫产史的患者，应尽早考虑AVM。栓塞仍是AVM的首选治疗方法，否则对于无生育需求或无法进行TAE的患者，确定性治疗是子宫切除术。
