title: Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes.
abstract: Uterine arteriovenous malformations (AVM) are rare and can be classified as either congenital or acquired. Acquired AVMs may result from trauma, uterine instrumentation, infection or gestational trophoblastic disease. The majority of acquired AVMs are encountered in women of reproductive age with a history of at least one pregnancy. Traditional therapies of AVMs include medical management of symptomatic bleeding, blood transfusions, uterine artery embolization (UAE) or hysterectomy. In this retrospective case series, we report our experience with AVM and UAE in five symptomatic women of reproductive age who wished to preserve fertility. Patients were 18-32 years old, and had 1-3 previous pregnancies prior to initial presentation. All patients were followed until their deliveries. All five patients delivered live births. Three of the five patients required two embolization procedures and one of these women required a subsequent hysterectomy. Two deliveries were at term and had normal weight babies and normal placenta. One woman had cerclage placed and developed chorioamnionitis at 34 weeks but had a normal placenta. Two pregnancies were induced <37 weeks for pre-eclampsia/b intrauterine growth restriction ± abnormal umbilical artery dopplers. The low birthweight were both <2000 g. Both placentas showed accelerated maturity and infarcts. All estimated blood losses were recorded as <500 cc. In conclusion, UAE may not be as effective at managing AVM as previously thought and should be questioned as an initial therapy in symptomatic women of reproductive age desiring fertility preservation.
authors.affiliation: The Fertility Clinic, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada angelos.vilos@lhsc.on.ca.
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Vilos
authors.affiliation: The Fertility Clinic, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Vilos
authors.affiliation: The Fertility Clinic, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Jackie
authors.initials: J
authors.lastname: Hollett-Caines
authors.affiliation: The Fertility Clinic, London Health Sciences Center, Victoria Hospital, London, Ontario, Canada Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Chandrew
authors.initials: C
authors.lastname: Rajakumar
authors.affiliation: Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada St. Joseph's Health Care, London, Ontario, Canada Department of Radiology, Western University, London, Ontario, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Garvin
authors.affiliation: Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada St. Joseph's Health Care, London, Ontario, Canada Department of Radiology, Western University, London, Ontario, Canada.
authors.forename: Roman
authors.initials: R
authors.lastname: Kozak
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000601:surgery*; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D055988:Uterine Artery / Q000002:abnormalities*; D055357:Uterine Artery Embolization / Q000379:methods*; D055815:Young Adult
keywords: arteriovenous malformation; menorrhagia; pregnancy outcomes; uterine artery embolization