Uterine Arteriovenous Malformations After Remission of Gestational Trophoblastic Disease: A Seven-Year Case Series from a Resource-Limited Tertiary Center

Abstract

Background: Uterine arteriovenous malformations (UAVMs) are rare but potentially life-threatening vascular abnormalities that may occur after gestational trophoblastic disease (GTD). Their clinical presentation may mimic other causes of abnormal uterine bleeding, creating diagnostic and therapeutic challenges, particularly in resource-limited settings.

Objective: To describe the clinical presentation, diagnostic evaluation, and management of uterine arteriovenous malformations occurring after remission of gestational trophoblastic disease and to discuss management strategies in a tertiary referral center.

Methods: we conducted a retrospective descriptive case series including patients diagnosed with UAVMs after documented remission of GTD between January 2015 and December 2022 at a tertiary referral center in Algeria. Data collected included patient characteristics, type of initial GTD, clinical presentation, imaging findings (Doppler ultrasound and pelvic angio-MRI), treatment modalities, and clinical outcomes. Therapeutic success was defined as complete cessation of uterine bleeding without additional intervention during 12 months of follow-up.

Results: Three patients aged 33–42 years were diagnosed with UAVM after GTD remission. Initial GTD consisted of one partial hydatidiform mole, one complete hydatidiform mole, and one low-risk gestational trophoblastic neoplasia (invasive mole). Severe metrorrhagia was the presenting symptom in all cases. Management included selective uterine artery embolization (n=1), emergency hysterectomy (n=1), and bilateral hypogastric artery ligation (n=1). Complete resolution of bleeding was achieved in all patients, with no recurrence during the 12-month follow-up.

Conclusion: UAVMs after GTD remission are rare but potentially severe complications. Diagnosis relies on β-hCG measurement and imaging techniques, including Doppler ultrasound and angio-MRI. Management should be individualized according to hemodynamic status, fertility desire, and available resources. Conservative approaches such as embolization or arterial ligation can be effective, while hysterectomy remains life-saving in emergency.