Acquired uterine arteriovenous malformation secondary to pregnancy in a cesarean scar: a diagnostic and therapeutic challenge

Abstract

Cesarean scar pregnancy is a rare but potentially life-threatening condition, associated with a high risk of massive hemorrhage and progression to severe vascular complications. We report the case of a patient with a history of previous cesarean section who was initially misdiagnosed with incomplete abortion and underwent uterine curettage, subsequently developing persistent uterine bleeding. Imaging studies revealed a uterine arteriovenous malformation associated with persistent trophoblastic tissue implanted within the cesarean scar. Despite medical treatment with methotrexate and the trend toward β-hCG negativization, uterine bleeding persisted; therefore, definitive surgical management with total abdominal hysterectomy was required. Histopathological examination confirmed the diagnosis of cesarean scar pregnancy complicated by a uterine arteriovenous malformation. This case highlights the importance of early ultrasound diagnosis, accurate differentiation from ongoing miscarriage, and individualized management to reduce maternal morbidity and mortality.