Cesarean scar pregnancy combined with arteriovenous malformation successfully treated with transvaginal fertility-sparing surgery: A case report and literature review

• Published in: Medicine (Baltimore) Vol. 99; no. 31; p. e21432
• Main Authors: Li, Xiangjuan, Sun, Wenchao, Chen, Lingna, Jin, Mei, Zhang, Zhifen, Gao, Jiansong, Fei, Xiaoyang
• Format: Journal Article
• Language: English
• Published: United States the Author(s). Published by Wolters Kluwer Health, Inc 31.07.2020; Wolters Kluwer Health
• Subjects: Adult; Angiography - methods; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - therapeutic use; Arteriovenous Malformations - complications; Arteriovenous Malformations - diagnostic imaging; Arteriovenous Malformations - drug therapy; Arteriovenous Malformations - surgery; Cesarean Section - adverse effects; Cicatrix - pathology; Cicatrix - surgery; Clinical Case Report; Female; Fertility Preservation - methods; Humans; Imaging, Three-Dimensional - methods; Magnetic Resonance Imaging - methods; Methotrexate - administration & dosage; Methotrexate - therapeutic use; Pregnancy; Pregnancy, Ectopic - surgery; Treatment Outcome; Ultrasonography, Doppler, Color - methods
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000021432

A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging. We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment. A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging. Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident. The fertility of the patient was preserved and hysterectomy was avoided. Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.