A 32-year-old woman, gravida 1 para 0, had a history of persistent trophoblastic disease, which was treated by dilation/curettage and chemotherapy at the age of 21. She visited a previous hospital wishing for a baby, but was referred to our hospital because the right side of the uterine myometrium was found to have been replaced by numerous dilated blood vessels. The contrast-enhanced CT revealed that dilated arteries and veins occupied the right uterine wall. The lesion was diagnosed as uterine arteriovenous malformation (UAVM) since pelvic veins were enhanced at the arterial phase. To counter the risk of perinatal hemorrhage, we recommended prepregnancy transcatheter arterial embolization (TAE). Pelvic angiography revealed that the right uterine artery was the main feeding artery of the UAVM. After the twice via the bilateral uterine arteries, the size of the UAVM lesion reduced from 49 mm to 35 mm. A contrast-enhanced CT after the second TAE showed a reduced blood flow from the uterine arteries, but persistent blood flow in the right round ligament artery to the UAVM was detected. Therefore, we performed the third TAE via the right round ligament artery. The size of the UAVM was decreased to approximately 30 mm, suggesting a reduced risk of pregnancy complications. As additional TEA might also evoke ovarian insufficiency due to excessive radiation exposure, we terminated the prepregnancy treatment. Four months after the last TAE, she conceived naturally. No enlargement of the UAVM or abnormal vaginal bleeding was observed during pregnancy. At 39 weeks of gestation, she delivered alive baby by vacuum extraction due to fetal dysfunction. The total blood loss at delivery was 975 g.
In conclusion, although TAE has been widely adopted as an effective treatment for UVAM, there has been no consensus on the treatment goal. Further reports should be accumulated to determine the cut-off value of UAVM size for a safe pregnancy.