Outcome in women undergoing uterine artery embolization for arterio-venous malformation diagnosed post- pregnancy- A retrospective study

Objective- To analyse the outcome of patients with symptomatic arterio-venous malformation(AVM), formed following pregnancy and managed by uterine artery embolization(UAE).

Method- This retrospective study was conducted after ethical approval and included 15 patients presenting with abnormal uterine bleeding following pregnancy, who were suspected to have an AVM which later was confirmed by angiography and managed with UAE. Presenting symptoms, post-UAE complications and subsequent fertility outcomes were noted. Follow-up period ranged from 6 months to 2.5 years.

Results- The mean age was 28.4±3.82 years and mean parity was 1.3. Out of 15 cases, 9(60%) presented after abortion, 4(26.6%) after normal vaginal delivery and 2(13.3%) after caesarean delivery; of these 10/15(66.7%) patients had history of curettage. The most common presenting symptom was continuous bleeding per-vaginum (BPV) since the antecedent pregnancy in 9/15(60%) patients and 6/15(40%) patients had irregular bleeding. Mean duration of symptoms was 91±85.7(30-360) days. For UAE, embolic agents used were polyvinyl alcohol(PVA) particles(300-500μm) in 2(13.3%), 30%glue injection in 3(20%), combination of PVA with glue injection in 4(26.6%) and PVA with gelfoam in 6(40%) patients. After UAE, bleeding responded within 3.6±0.97(3-6) days in all but one patient who required repeat UAE one month later. All women resumed normal menstrual cycle in 31.3±5.2(24-42) days. Ten patients desired conception, of whom 5(50%) conceived within 13.2±5.1(6-19) months after UAE. Two women carried pregnancy till term, one underwent preterm caesarean for growth restriction with oligohydramnios. One patient had postpartum hemorrhage which was managed medically. One had spontaneous abortion at 6 weeks gestation and other is 13weeks pregnant at present.

Conclusion- UAE is an effective treatment modality for management of symptomatic post-pregnancy AVMs.