A REPORT FOR A CASE OF UTERINE ARTERIOVENOUS MALFORMATION CO-EXISTING WITH A PLACENTA ACCRETA IN A 30-YEAR-OLD POST CURETTAGE FOR MISSED MISCARRIAGE

Problem statement: This unique case report outlines the complexities surrounding a 30-year-old woman experiencing recurrent and persistent first-trimester vaginal bleeding after undergoing two curettages for missed miscarriages. The distinctive nature of this case is marked by the co-existence of uterine arteriovenous malformation (UAVM) and placenta accreta, both rare conditions that are infrequently found to be the underlying causes of early pregnancy bleeding.

Methods: However, after an equivocal hysteroscopy, the utility of advanced diagnostic modalities, including transvaginal ultrasonography with Doppler studies and pelvic angiography, facilitated the confirmation of a UAVM diagnosis. Embolization therapy was subsequently implemented successfully, culminating in the cessation of the vaginal bleeding.

Results: Unexpectedly, a month later, the vaginal bleeding recurred. A subsequent transvaginal ultrasound revealed focal placenta accreta, a condition known for its implications on fertility. In response to this, methotrexate therapy was initiated, which led to the ultimate cessation of vaginal bleeding.

Conclusion: This case accentuates the critical value of comprehensive diagnostic methodologies, particularly Doppler ultrasonography and pelvic angiography, in managing complex and rare obstetric conditions like UAVM and placenta accreta. It underscores the importance of clinical vigilance, thorough evaluation, and the formulation of individualized treatment plans that align with patients` fertility preservation goals. The insights gleaned from this case may contribute significantly to the understanding and management of complex obstetric conditions.