Postpartum hemorrhage as a result of acquired uterine arteriovenous fistula post-vaginal delivery

Objective: A 24-year-old woman with secondary postpartum hemorrhages stemming from a Acquired uterine arteriovenous fistula (UAVF) induced after spontaneous vaginal delivery without a history of artificial removal of the placenta during childbirth. The initial diagnosis using conventional ultrasonography resulted in the suspicion of a UAVF, digital subtraction arteriography confirmed the lesion of typical UAVF. Hysteroscopy detected a false passage in the uterus. An acquired UAVF generally results from trauma, which can often be confused with retained products of conception. Results: Pelvic DSA was promptly performed, proving the earlier suspicion of the lesion of typical UAVF over the left uterine artery. UAE of the bilateral uterine arteries was immediately carried out with microspheres for embolization, occluding active bleeders. Conclusions: UAVF, induced after spontaneous vaginal delivery without artificial removal of the placenta, is a rare cause of postpartum vaginal bleeding. Timely diagnosis is of utmost importance. The few published case series and single case report of UAVF may represent the tip of the iceberg. By sharing this case report, we hope our experience will add to obstetricians and gynecologists an increasing awareness that UAVFs may be more common than previously thought and more attention to UAVF in clinical work, so patients can undergone appropriate diagnostic and treatment.