Successful Management of Cesarean Scar Pregnancy Complicated by an Arteriovenous Malformation.

Background: Cesarean scar ectopic pregnancies are rare, with an incidence of approximately 1 in 2,000 pregnancies. The trauma of a cesarean section and a subsequent cesarean scar pregnancy can lead to the formation of an arteriovenous malformation (AVM). The resulting intractable bleeding is difficult to manage and can result in an emergent surgical intervention that could jeopardize a female's ability to become pregnant in the future.

Case Report: A 29-year-old female, gravida 2 para 1, with 1 prior low transverse cesarean section had a presumed cervical ectopic pregnancy treated with intramuscular methotrexate. Despite a negative serum beta human chorionic gonadotropin result, she had a persistent mass in the lower uterine segment of her cesarean section scar and was finally diagnosed with an AVM. We successfully preserved her fertility by performing a wedge resection of the AVM and using a novel technique of bilateral O'Leary sutures to occlude the ascending and descending branches of the uterine artery along with intramuscular vasopressin infiltration.

Conclusion: A multidisciplinary approach involving obstetrics/gynecology, interventional radiology, and anesthesiology allowed for a safe conservative surgical approach and the preservation of our patient's fertility.