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Case Report
Term delivery following spontaneous resolution of uterine arteriovenous malformation with subsequent in vitro fertilization
1 BS, Medical Student, Department of Obstetrics and Gynecology, Creighton University, Omaha, Nebraska, USA
2 MD, MS, Resident Physician, PGY-III, Department of Obstetrics and Gynecology, Creighton University, Omaha, Nebraska, USA
3 MD, FACOG, Residency Program Director and Assistant Professor, Department of Obstetrics and Gynecology, Creighton University, Omaha, Nebraska, USA
Address correspondence to:
Meaghan Shanahan
MD, FACOG, Program Director and Assistant Professor, Department of Obstetrics and Gynecology, Creighton University, School of Medicine, Omaha, Nebraska,
USA
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Article ID: 100056Z08BF2020
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Fenske BM, Burgart JM, Shanahan M. Term delivery following spontaneous resolution of uterine arteriovenous malformation with subsequent in vitro fertilization. J Case Rep Images Obstet Gynecol 2020;6:100056Z08BF2020.ABSTRACT
Introduction: A uterine arteriovenous malformation (AVM) is an abnormal connection between the arterial and venous systems and is clinically relevant due to the risk of hemorrhage and death. Arteriovenous malformations are often treated with uterine artery embolization which may compromise fertility. Conservative management is one treatment option that can preserve fertility; however, limited data has documented fertility success after conservative management, especially in the context of later pregnancy achieved by in vitro fertilization (IVF). This case report presents a successful case of IVF after spontaneous resolution of a uterine AVM.
Case Report: A 40-year-old G1P0100 Caucasian female presented to a six-week postpartum visit with episodic vaginal bleeding after spontaneous vaginal delivery of a previable infant in the setting of preterm premature rupture of membranes complicated by chorioamnionitis. Transvaginal ultrasound (TVUS) and pelvic magnetic resonance imaging (MRI) were consistent with a uterine AVM. Due to the desire for fertility preservation, the patient elected for conservative management, and spontaneous resolution of the lesion was seen on TVUS six weeks later. Successful pregnancy was later achieved with IVF and resulted in delivery of a healthy term infant.
Conclusion: Conservative management is a viable treatment option for hemodynamically stable patients with uterine AVMs who desire future fertility. In this case, this abnormality did not preclude the patient from becoming pregnant and having a successful obstetric outcome. While risks do exist with conservative management, ultimately the treatment of patients with uterine AVMs must be individualized, and the clinical picture must be balanced with the wishes of the patient.
Keywords: In vitro fertilization, Pregnancy, Uterine arteriovenous malformation
SUPPORTING INFORMATION
Author Contributions
Brooke Malia Fenske - Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jennifer Marie Burgart - Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Meaghan Shanahan - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Brooke Malia Fenske et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
