Abstract
Abstract
Background
Cervical arteriovenous malformation (AVM) is an exceedingly rare condition that can cause antepartum hemorrhage, resulting in perinatal and maternal morbidity. Diagnosing this condition definitively prior to delivery can prove challenging, especially when extensive bleeding necessitates emergency surgery.
Case presentation:
We report a case of a 30-year-old primigravida woman, at a gestational age of 31+ 2 weeks, who presented to the hospital with an initial episode of third-trimester antepartum hemorrhage. A speculum examination revealed a 500 mL blood clot and fresh blood in the vagina. Notably, the cervical os appeared closed and devoid of any abnormal lesions. Her antenatal care history and second-trimester ultrasonography were unremarkable. Despite a thorough clinical examination and ultrasonography, the cause of the antepartum hemorrhage remained elusive. An emergency cesarean section was initiated 30 minutes postadmission due to a subsequent episode of bleeding accompanied by hypovolemic shock and a fetal NICHD category III assessment. Following the delivery of the fetus, a pulsatile tubular structure was identified at the endocervix. Suture ligation was executed, followed by Bakri balloon insertion, effectively controlling the bleeding with an estimated blood loss of 1200 mL. After transfusing 4 units of packed red blood cells, the patient’s postpartum course progressed without complications. The newborn was discharged 49 days postdelivery. A pathological biopsy confirmed the intraoperative diagnosis of AVM.
Conclusion
Cervical AVM, although rare, poses a life-threatening risk. Obstetricians should remain vigilant regarding this condition, especially when faced with inexplicable antepartum hemorrhage, even in primigravida cases. Our case underscores the effectiveness of a combined approach—suture ligation and balloon tamponade—in managing the hemorrhage arising from this condition.
Publisher
Research Square Platform LLC