Commentary| Volume 88, ISSUE 3, P326-329, September 2013

Controversies in family planning: arteriovenous malformation

      JG is a 25-year-old G2P0 female with one previous uneventful medical abortion in October 2008 and no live children. In December 2009, she was admitted to a hospital with a first episode of severe vaginal bleeding. An arteriovenous malformation (AVM) was suspected on a vaginal ultrasound and was confirmed by Doppler ultrasound and an MRI. These studies demonstrated a dilated vessel arising from the left uterine artery, reaching almost to the endometrial surface and ending as a cystic 15-mm formation with demonstrable internal flow (Fig. 1, Fig. 2, Fig. 3). The hemorrhage stopped spontaneously and no treatment was initiated. She had a second episode of bleeding in April which again stopped by itself. No transfusions were needed but her hemoglobin dropped to 9 mg/mL each time. Apart from these two episodes, her menses remained regular and normal in quantity.
      Figure thumbnail gr1
      Fig. 1MRI, Coronal view. Arrow: AVM.
      Figure thumbnail gr3
      Fig. 3Doppler ultrasound. Arrow: AVM.
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