Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence!

A 23-year-old lady presented with a 10-month history of multiple episodes of prolonged and erratic menstrual bleeding having undergone a surgical termination of pregnancy. Initially, pelvic ultrasound and hysteroscopy were found to be normal and for many months she was treated pharmacologically for dysfunctional uterine bleeding. She also tried both a copper-coil and MIRENA intrauterine system, which were both expelled due to heavy bleeding characterised by 'a clot the size of two fists'.