A Case of Retained Products of Conception Adherent to the Caesarean Scar Site with AV Malformation Managed with Uterine Artery Embolisation
Abstract:
Retained products of conception (RPOC)
and uterine arteriovenous malformations (AVM) are uncommon but serious causes
of abnormal uterine bleeding (AUB). This case involves a 29-year-old woman,
Para 2 Live 2, with a history of two caesarean sections and two previous
abortions, who experienced heavy menstrual bleeding following medical
termination of pregnancy (MTP) and tubectomy. Initially managed conservatively
with methotrexate, she presented again a month later with recurrent AUB.
Ultrasound and Doppler imaging revealed a thickened endometrium with
significant vascularity, indicating RPOC and uterine AVM. Her β-HCG levels were
elevated (47.13) but trended downward upon repeat testing. Based on
interventional radiology advice, she underwent bilateral uterine artery
embolization (UAE) with gel foam. Following the procedure, the patient's
symptoms improved significantly, with a noticeable reduction in both the
frequency and intensity of her bleeding episodes. Her β-HCG levels continued to
decline, and no further episodes of heavy bleeding were noted during the
one-month follow-up. This case highlights the diagnostic challenges associated
with RPOC and uterine AVM, particularly after abortion. Doppler ultrasound
plays a key role in detecting vascular abnormalities. Uterine artery
embolization is an effective and safe first-line treatment, reducing hemorrhage
risk and the need for hysterectomy. Early identification and intervention are
critical to prevent life-threatening complications and ensure a favorable outcome.
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