OC13.10: Three‐dimensional colour Doppler before and after embolisation of postpartum acquired enhanced myometrial vascularity/arteriovenous malformation

A 38-year-old primigravida with a history of hysteroscopic resection for uterine septum had a massive postpartum hemorrhage following spontaneous vaginal delivery and difficult manual removal of the placenta. The hemorrhage stopped following intrauterine balloon tamponade and the patient was discharged after 48 hours from delivery in good conditions. At transvaginal ultrasound scan performed 15 days after delivery (figure 1, pre-embolisation), intrauterine placental remnants were still visualised with scarce vascularisation. In the right isthmic region, tortuous, anechoic structures were seen inside the myometrium by 2D greyscale ultrasound. On colour Doppler these structures represented blood vessels concentrated in a small area of myometrium adjacent to the uterine cavity in the right isthmic region. The ultrasound findings were compatible with acquired enhanced myometrial vascularity/arteriovenous malformation. Conservative management was decided, and a repeat scan was planned after 14 days. However, the patient presented 10 days later with severe uterine bleeding which was treated with selective uterine artery embolisation. Post-procedure ultrasound revealed almost complete disappearance of the enhanced myometrial vascularity (figure 1, post-embolisation). The patient was discharged after 48 hours. One month after the procedure the patient was asymptomatic with almost completely involuted uterus and significant reduction of the dimensions of the intrauterine remnants. Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.