Fertility and Obstetric and Clinical Outcomes following Embolization Management of Symptomatic Pregnancy-Related Arteriovenous Malformations: Two Decades of Follow-up from a Tertiary Medical Center

Abstract

Purpose

To evaluate fertility and obstetric and clinical outcomes following uterine artery embolization (UAE) for pregnancy-related symptomatic uterine arteriovenous malformations (AVMs).

Materials and Methods

A retrospective case analysis was conducted at a single tertiary care center and included women diagnosed with symptomatic post-pregnancy uterine AVMs treated between January 2000 and April 2023. Clinical data, management strategies, and follow-up outcomes were extracted from institutional records. A follow-up phone survey was conducted to assess fertility and obstetric outcomes.

Results

Forty women with symptomatic uterine AVMs were identified. All presented with vaginal bleeding, the sole symptom in 35 cases (87.5%). Most (31/40, 77.5%) presented at the emergency department within 24 hours. Thirty-eight women (95%) required one UAE; no hysterectomies were performed. Twelve women (30%) experienced massive bleeding requiring transfusion. Of 35 women who responded to the fertility survey, 22 (62.8%) desired a future pregnancy. Of these, 20 (90.9%) achieved pregnancy, with 17 (85%) delivering at term. The median time to conception was under 6 weeks, and 65% conceived within 12 months. Ten women (50%) had multiple successful pregnancies; one had 5 consecutive pregnancies. Regarding post-UAE pregnancies, 4 women (23.5%) experienced abnormal placentation, but no AVM recurrences were reported.

Conclusion

In this cohort, UAE for AVMs is highly effective and fertility-sparing, with most women conceiving and delivering successfully. Obstetric risks remain notable, underscoring the need for larger studies to confirm these findings and assess long-term risks.

Zusammenfassung

Ziel

Bewertung der Fertilität sowie der geburtshilflichen und klinischen Outcomes nach Uterus-Arterienembolisation (UAE) bei symptomatischen schwangerschaftsbedingten arteriovenösen Malformationen (AVMs) der Gebärmutter.

Material und Methoden

Es wurde eine retrospektive Fallanalyse in einem einzigen tertiären medizinischen Zentrum durchgeführt. Eingeschlossen wurden Frauen mit symptomatischen postpartalen AVMs, die zwischen Januar 2000 und April 2023 behandelt wurden. Klinische Daten, Behandlungsstrategien und Nachsorgebefunde wurden aus den Patientenakten extrahiert. Eine telefonische Nachbefragung diente der Erfassung der Fertilität und des geburtshilflichen Outcomes.

Ergebnisse

Es wurden 40 Frauen mit symptomatischen uterinen AVMs identifiziert. Alle litten unter vaginalen Blutungen, die in 35 Fällen (87,5%) das einzige Symptom waren. Die meisten (31/40, 77,5%) stellten sich innerhalb von 24 Stunden in der Notaufnahme vor. Achtunddreißig Frauen (95%) benötigten eine UAE; es wurden keine Hysterektomien durchgeführt. Zwölf Frauen (30%) erlitten massive Blutungen, die eine Transfusion erforderlich machten. Von den 35 Frauen, die an der Fertilitätsumfrage teilnahmen, hatten 22 (62,8%) einen Kinderwunsch. Von diesen wurden 20 (90,9%) schwanger, wobei 17 (85%) termingerecht entbanden. Die mediane Zeit bis zur Konzeption betrug weniger als 6 Wochen, und 65% wurden innerhalb von 12 Monaten schwanger. Zehn Frauen (50%) hatten mehrere erfolgreiche Schwangerschaften; eine Frau hatte 5 aufeinanderfolgende Schwangerschaften. In Bezug auf Schwangerschaften nach UAE traten bei 4 Frauen (23,5%) abnormale Plazentationsstörungen auf, aber es wurden keine AVM-Rezidive berichtet.

Schlussfolgerung

In dieser Kohorte ist die UAE bei AVMs hochwirksam und fertilitätserhaltend, da die meisten Frauen schwanger wurden und erfolgreich entbanden. Die geburtshilflichen Risiken bleiben jedoch erheblich, was die Notwendigkeit größerer Studien unterstreicht, um diese Ergebnisse zu bestätigen und die langfristigen Risiken zu bewerten.

Keywords

embolization - fertility - pregnancy - Gynecology - uterine arteriovenous malformation

Publication History

Received: 13 May 2025

Accepted after revision: 02 January 2026

Article published online:
10 February 2026

• References

• 1 Ghai S, Rajan DK, Asch MR. et al. Efficacy of embolization in traumatic uterine vascular malformations. J Vasc Interv Radiol 2003; 14: 1401-1408
• 2 Hoffman MK, Meilstrup JW, Shackelford DP. et al. Arteriovenous malformations of the uterus: an uncommon cause of vaginal bleeding. Obstet Gynecol Surv 1997; 52: 736-740
• 3 Kasznica J, Nisav N. Congenital vascular malformation of the uterus in a stillborn: a case report. Hum Pathol 1995; 26: 240-241
• 4 Delotte J, Chevallier P, Benoit B. et al. Pregnancy after embolization therapy for uterine arteriovenous malformation. Fertil Steril 2006; 85: 228
• 5 Timmerman D, Van den Bosch T, Peeraer K. et al. Vascular malformations in the uterus: Ultrasonographic diagnosis and conservative management. Eur J Obstet Gynecol Reprod Biol 2000; 92: 171-178
• 6 Bandura P, Rawnaq T, Holzknecht A. et al. Management of Intrauterine Arteriovenous Malformation (AVM) in 14 Patients by Sonographically Guided Tisseel Application. Ultraschall in Med 2018; 39 (01) 48-55
• 7 Degani S, Leibovitz Z, Shapiro I. et al. Expectant management of pregnancy-related high-velocity uterine arteriovenous shunt diagnosed after abortion. Int J Gynaecol Obstet 2009; 106: 46-49
• 8 Mekaru K, Oishi S, Akamine K. et al. Spontaneous regression of uterine arteriovenous malformations with conservative management. Case Rep Obstet Gynecol 2017; 2017: 6437670
• 9 Molvi SN, Dash K, Rastogi H. et al. Transcatheter embolization of uterine arteriovenous malformation: report of 2 cases and review of literature. J Minim Invasive Gynecol 2011; 18: 812-819
• 10 Eling R, Kent A, Robertson M. Pregnancy after uterine arteriovenous malformation-case series and literature review. Australas J Ultrasound Med 2012; 15: 87-96
• 11 Torre A, Paillusson B, Fain V. et al. Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms. Hum Reprod 2014; 29: 490-501
• 12 Vaknin Z, Sadeh-Mefpechkin D, Halperin R. et al. Pregnancy-Related Uterine Arteriovenous Malformations: Experience from a Single Medical Center. Ultraschall in Med Eur J Ultrasound 2011; 32 (Suppl. 02) E92-E99
• 13 Delplanque S, Le Lous M, Proisy M. et al. Fertility, pregnancy, and clinical outcomes after uterine arteriovenous malformation management. J Minim Invasive Gynecol 2019; 26: 153-161
• 14 Goldberg J, Pereira L, Berghella V. Pregnancy after uterine artery embolization. Obstet Gynecol 2002; 100: 869-872
• 15 Ghanaati H, Firouznia K, Moradi B. et al. Fertility Outcomes After Uterine Artery Embolization for Symptomatic Uterine Arteriovenous Malformations: A Single-Center Retrospective Study in 33 Women. Cardiovasc Intervent Radiol 2022; 45: 983-991
• 16 Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94: 324-330
• 17 McLucas B. Pregnancy following uterine artery embolization: an update. Minim Invasive Ther Allied Technol 2013; 22: 39-44
• 18 Oride A, Kanasaki H, Miyazaki K. Disappearance of a uterine arteriovenous malformation following long-term administration of oral norgestrel/ethinyl estradiol. J Obstet Gynaecol Res 2014; 40: 1807-1810
• 19 Hugues C, Le Bras Y, Coatleven F. et al. Vascular uterine abnormalities: comparison of imaging findings and clinical outcomes. Eur J Radiol 2015; 84: 2485-2491
• 20 Timor-Tritsch IE, Haynes MC, Monteagudo A. et al. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations. Am J Obstet Gynecol 2016; 214: 731.e1-731.e10
• 21 Rubod C, Mubiayi N, Robert Y. et al. Uterine arteriovenous malformation: A rare cause of recurrent metrorrhagia. Gynecol Obstet Fertil 2005; 33: 511-513
• 22 Ghai S, Rajan DK, Asch MR. et al. Efficacy of embolization in traumatic uterine vascular malformations. J Vasc Interv Radiol 2003; 14: 1401-1408
• 23 Berkane N, Moutafoff-Borie C. Impact of previous uterine artery embolization on fertility. Curr Opin Obstet Gynecol 2010; 22: 242-247
• 24 ACOG Committee Opinion. Uterine artery embolization. Obstet Gynecol 2004; 103: 403-404
• 25 Ravina JH, Aymard A, Ciraru-Vigneron N. et al. Uterine fibroids embolization: results about 454 cases. Gynecol Obstet Fertil 2003; 31: 597-605
• 26 Stiepel III HR, Burke CT, Stewart JK. Embolization of uterine arteriovenous malformation causing postpartum hemorrhage using n-butyl cyanoacrylate: a case report. Radiol Case Rep 2021; 16: 1188-1190
• 27 Firouznia K, Ghanaati H, Sanaati M. et al. Uterine artery embolization in 101 cases of uterine fibroids: do size, location, and number of fibroids affect therapeutic success and complications?. Cardiovasc Intervent Radiol 2008; 31: 521-526
• 28 Jegaden M, Bleas C, Debras E. et al. Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes. J Minim Invasive Gynecol 2023; 30: 494-501
• 29 Hehenkamp WJ, Volkers NA, Donderwinkel PF. et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol 2005; 193: 1618-1629