Welcome to the ePoster Viewing Panel of AICOG 2025

INTRODUCTION- An Arteriovenous malformation (AVM) is essentially an abnormal vascular structural anomalous connection between arteries and veins that bypass the capillaries. While they can be found anywhere in the body, uterine AVMs are relatively rare with only about 100 cases having been reported in literature to date. AIMS AND OBJECTIVES- A Poster Presentation describing an atypical presentation and subsequent management of a uterine AVM which initially appeared to resemble products of conceptus. Uterine Artery Embolisation was performed to save the uterus from the associated complications of having to perform an emergency hysterectomy while also preserving the fertility. MATERIALS AND METHODS : 32 y/o Female ,P2L2MTP2 came to OPD with bleeding Per vaginum since one month following 2 months of amenorrhea with UPT negative status . On examination the patient had tachycardia with low Blood pressure and was anaemic due to chronic bleeding .A per speculum examination showed presence of bleeding from the internal os while on a bimanual per vaginal examination, the uterus was found to be bulky, and bilateral fornices were free and non-tender. Serum Beta HCG was mildly raise (36 mIU/L) USG and CT angiogram showed bulky uterus with with heterogenous echo texture with echogenic areas with few anechoic areas within and increased vascularity within the myometrium which extended into the endometrial cavity. Multiple dilated veins were seen in bilateral adnexa. This led to a differential of uterus Arteriovenous malformation (AVM) versus grade 3 retained products of conceptus (RPOC). RESULTS: Considering the high PSV and the type of vascular flow within the myometrium, the diagnosis was more inclined towards AVM.To be double sure, we tested her beta HCG level and performed a pelvic angiogram for better visualisation. It showed hypertrophied bilateral uterine arteries and intrauterine spiral arteries with prominent uterine blush, Bilateral external iliac arteries and infrarenal abdominal aortogram was normal. In view of these findings, uterine artery embolization was decided upon and she was taken up for the embolization with right femoral access. Post procedural angiogram revealed near total (99%) reduction in vascularity of mass lesion. Post procedure recovery of the patient was uneventful. CONCLUSION: In the past, AVMs were traditionally diagnosed by laparotomy or incidentally, during examination of the uterus after a hysterectomy . Presently, ultrasound with colour doppler studies is primarily used to detect this rare condition. While it is safe and non-invasive with no radiation exposure, to date,digital subtraction angiography remains the gold standard of diagnosis. Owing to the often hemodynamically unstable nature of the patients .. However, with advancements in interventional radiology, transcatheter vascular embolization (TCE) is a viable alternative treatment option for patients wishing to preserve fertility. Hysterectomy for uterine AVMs has largely taken a backseat and is reserved only for life threatening cases in relatively resource-poor areas. For most others, UAE could very well be the treatment of choice that is minimally invasive and preserves fertility as well. The simplicity and minimal adverse effects of the procedure has made it preferable, in resource-rich settings with the availability of competent infrastructure, UAE is often chosen as the first-line treatment nowadays.