I hope to provide information for other women with an arteriovenous malformation in the uterus.
I had this condition, which was diagnosed in 1992, after a series of
massive haemorrhages. This condition is often considered life threatening if untreated, and is very rare, although cases of AVM in the brain are more frequently identified. Arteriovenous Malformation is a rare condition in which a section of
blood vessels lacks a capillary network, resulting in blood from an artery being delivered directly to a vein. This places pressure on the vein, which over time, may weaken and burst, causing a haemorrhage. It is believed this condition may be congenital or acquired. It is also known as Arteriovenous Fistula* or Cirsoid Aneurysm. Uterine AVM is often characterised by massive vaginal bleeding. Pain may or may not be present. My condition was initially diagnosed in Vancouver, Canada although I returned to Australia for treatment. At the time of initial diagnosis, I was told I might die unless I underwent a hysterectomy. I was treated in the Royal Melbourne Hospital where I learned I was one of a small handful of similar cases seen in the previous 5 years in both the Royal Melbourne and Royal Women's Hospitals. Diagnosis was made by angiography and at the same time, I underwent treatment, which involved embolizing (blocking) some of the arteries and veins. I had separate 2 treatments under pelvic angiography. Although it is a condition of the uterus, my AVM was treated not by a gynaecologist but by radiologist, Professor Ken Thomson. (Royal Melbourne Hospital) At the time, he said he had seen about 3 other women with this condition in the past 20 years. (Note - He has 3 or 4 several other patients since then) He had never personally heard of a woman who had been diagnosed & treated with an AVM having a successful pregnancy, however he was able to locate an article from a European medical journal which described such a pregnancy. My treatment was partially successful. Some of the arteries and veins which contributed to the AVM were destroyed, but the area was large and it could not be completely obliterated without possibly
compromising the blood supply to the uterus. I became pregnant in 1993 and had a healthy baby boy on 7 July '94. I did not experience any complications associated with the birth, although it was expected that I would probably haemorrhage after the delivery of the placenta. I had another haemorrhage in May '95, which was monitored but not treated. I became pregnant again, with the AVM still present and delivered a healthy baby boy on 26 August 1996. The delivery was induced due to haemorrhaging at term and was complicated by uncontrollable haemorrhaging during the delivery of the placenta which was retained. I received 2 units of blood and underwent an emergency D&C for removal of the placental fragments and to prevent further haemorrhaging . It was discovered that I had placenta accreta,
an unusual complication of pregnancy and childbirth
in which the placenta grows deeply into the uterine wall. The treating obstetrician said he believed this condition was unrelated to the AVM, however another documented case of pregnancy following AVM was also complicated by placenta accreta, so I believe there could be a connection. I did not imagine I would ever be able to have a successful pregnancy
after the grim diagnosis and the lack of information about this condition. There is little known about this condition and how it affects pregnancy. I am happy to provide information or support to anyone who has this condition, or who has a friend or relative with an AVM in the uterus. Anyone who has this problem may also want to hear about my treatment and gain some encouragement from my healthy pregnancies and deliveries. Additionally, I receive a small but steady stream of email from women who have this condition, so if you have this condition and can offer support, information or details of medical practitioners who are familiar with treating uterine AVM, I am happy to keep details of this information, pass it on or put people in touch with one another In February 2001, after many years symptom free, I had another small haemorrhage. After spending a few days in hospital for observation and consulting the doctors, we mutually agreed that the safest route for me would be to have a hysterectomy, which was performed in April 2001. We had no plans for more children and it seemed like a sensible option, given that the AVM was still present and had grown bigger. I have transcribed several articles from medical journals which may be of interest to women who have this unusual condition. The articles are readily available through medical libraries or I am happy to post or email these to people who seek further information on uterine AVM. I would also be interested to receive further journal references from anyone who may be interested in sharing information. My thanks go to Prof. Ken Thomson, Royal Melbourne Hospital,(now Alfred Hospital, Melbourne Australia) and in Canada - Drs Peter Cooperberg and Matt Garrey, St Paul's Hospital Vancouver, and Dr Bronnie Hautala, Family Practice, Burnaby BC for all their help with my treatment and ante & postnatal care. Cath Fisher
REFERENCES
-Chow et al (1995): Pregnancy following successful embolisation of a uterine vascular
malformation. Br J Obstet & Gynaecol Feb 1995 Vol 102 pp 166 168.
Click Here to read Journal Articles about Uterine AVM
-Poppe et al (1987): Pregnancy after transcatheter embolization of a uterine arteriovenous
malformation. Am J Obstet Gynecol 156, 1179 1180
-Vogelzang et al (1991): Uterine Arteriovenous Malformations: Primary Treatment with
Therapeutic Embolization. JVIR 2:517-522
-T.K. Gnosh (1986): Arteriovenous Malformation of the Uterus and Pelvis. Obstet
Gynecol Vol 68 #3 suppl.
-Fleming et al (1989): Arteriovenous Malformation of the Uterus. Obstet Gynecol 73, 2
Feb 1989
-Markoff et al (1986) Uterine arteriovenous malformation successfully embolized with a
liquid polymer, isobutyl 2-cyanocrylate. Am J Obstet Gynecol 155:659-60
For support or information on Uterine AVM, references or if you would like to request or provide a journal article, please contact me.
send email I am not a medical professional and I do not represent any practitioner, hospital or organisation. I do not claim to have any medical training, although I have personally experienced this condition and have researched available data and interviewed other women with AVM in the uterus. The information I have quoted comes both from my own experiences and the medical journals cited above. I will attempt to answer all enquiries immediately but please be patient if it takes a while to respond.
Internet Resources for people with AVM
VASANOM: Blood Vessel Malformation On-line Discussion Groups. Contains information for joining mailing list.|
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A small email contact list of others with Uterine AVM |
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HONcode principles  Health On the Net Foundation |
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