TITLE:
A Multi-Disciplinary Approach of a Patient with Extensive Arterio-Venous Malformations Undergoing a C-Section
AUTHORS:
Jing Song, Sudheera Kokkada Sathyanarayana, Louvonia Boone, Vilma Joseph
KEYWORDS:
Uterine Arteriovenous Malformation; Pelvic Arteriovenous Malformation; Cesarean Section; Management Anesthesia Care; Extracorporeal Life Support
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.4,
June
4,
2013
ABSTRACT: 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.