The presence of both uterine and arteriovenous malformation in a patient is rare. For these patients a cesarean section can be life threatening due to uncontrolled massive hemorrhage. Prevention and control of massive...The presence of both uterine and arteriovenous malformation in a patient is rare. For these patients a cesarean section can be life threatening due to uncontrolled massive hemorrhage. Prevention and control of massive blood loss utilizing a multidisciplinary approach can be lifesaving. We present a case report of a 33 years old pregnant woman at 35 weeks of gestation diagnosed with an extensive uterine arteriovenous malformation and innumerable tortuous vessels who was scheduled for a cesarean section. Her previous vaginal delivery was complicated by significant bleeding requiring uterine artery embolization. Pre-operative prophylactic aortic and right iliac artery balloon occlusion catheters were placed under monitored anesthesia care. The extracorporeal life support team was available to initiate veno-venous or arteriovenous bypass. Cesarean section was performed with careful identification of the uterine vessels under ultrasound guidance and ultimately the bleeding was well controlled. Postoperatively, the patient underwent uterine artery embolization. It is our strong belief that although we did not face a major disaster during this cesarean section, our comprehensive plan and multi-disciplinary approach were essential to ensuring the safety of the parturient and newborn.展开更多
文摘The presence of both uterine and arteriovenous malformation in a patient is rare. For these patients a cesarean section can be life threatening due to uncontrolled massive hemorrhage. Prevention and control of massive blood loss utilizing a multidisciplinary approach can be lifesaving. We present a case report of a 33 years old pregnant woman at 35 weeks of gestation diagnosed with an extensive uterine arteriovenous malformation and innumerable tortuous vessels who was scheduled for a cesarean section. Her previous vaginal delivery was complicated by significant bleeding requiring uterine artery embolization. Pre-operative prophylactic aortic and right iliac artery balloon occlusion catheters were placed under monitored anesthesia care. The extracorporeal life support team was available to initiate veno-venous or arteriovenous bypass. Cesarean section was performed with careful identification of the uterine vessels under ultrasound guidance and ultimately the bleeding was well controlled. Postoperatively, the patient underwent uterine artery embolization. It is our strong belief that although we did not face a major disaster during this cesarean section, our comprehensive plan and multi-disciplinary approach were essential to ensuring the safety of the parturient and newborn.
