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Anesthetic Managment of the Pregnant Patient with Uterine Arteriovenous Malformation
Abstract Number: F-55
Abstract Type: Case Report/Case Series
Uterine artery arteriovenous malformation (AVM) is a rare cause of blood loss during pregnancy. An AVM is an abnormal communication between artery and vein, and rupture of a uterine artery AVM can be life-threatening for both mother and fetus. There are few case reports in the literature describing uterine artery AVM in the pregnant patient, and even fewer describing appropriate anesthetic management of this challenging situation. We present a case of a 29 year old G1P0 patient at 32 weeks gestation who presented with severe abdominal pain, subsequent hemodynamic collapse and loss of consciousness. Four similar episodes were reported during this pregnancy requiring blood transfusions and even a diagnostic laparoscopy. CT angiography revealed uterine artery pseudoaneurysm and suspected AVM. Multiple subspecialties were involved in this case, including Interventional Radiology (IR), Vascular Surgery, Radiology, Urology, Gynecological Oncology and Anesthesiology. Thorough planning was necessary to ensure the safe management of the patient and her child. She ultimately underwent successful operative cesarean section under general anesthesia following placement of an occlusion balloon catheter in IR preoperatively and AVM embolization was completed immediately post operatively. This case highlights the importance of preparation by the Anesthesia care team, and communication between the multiple healthcare providers involved. Awareness of uterine artery AVM as a cause of bleeding during pregnancy, as well as in the postpartum period, is essential to providing safe anesthetic management in these rare cases.
1.Cornette J, Van der Wilk E, Janssen N, Van der Weiden R, Jenninkens S, Pattynama P, Duvekot J. Uterine Artery Pseudoaneurysm Requiring Embolization During Pregnancy. Obstetrics & Gynecology 2014;123:453-456.
2.Grivell R, Reid K, Mellor A. Uterine Arteriovenous Malformations: A Review of the Current Literature. Obstetrical & Gynecological Survey 2005;761-767.
3.Kulkarni S, Teoh W, Sia A, Nair S. Ruptured uterine artery pseudoaneurysm: an overlooked cause of late postpartum haemorrhage. Acta Anaesthesiol Belg 2013;64(4):159-62.