Uterine Arteriovenous Malformation with Sudden Heavy Vaginal Hemmorhage

Dysfunctional uterine bleeding (DUB) is a common presentation in the emergency department and has a wide differential. Most presentations of DUB are in hemodynamically stable patients and can be evaluated as an outpatient. Uterine arteriovenous malformation (AVM) is one presentation that can result in a life-threatening medical emergency with unexpected sudden and massive vaginal bleeding. We describe a case of a 24-year-old female with sudden heavy vaginal bleeding requiring a blood transfusion, ultrasound evidence of uterine AVM, and a treatment method of expectant management using an intrauterine device in an attempt to preserve fertility. [West J Emerg Med. 2013;14(5):411–414.] CASE REPORT A 24-year-old female, G3P0030 with a history of depression presented to the emergency department (ED) for evaluation of abrupt heavy vaginal bleeding. The patient noticed a sudden gush of blood between her thighs, prompting her visit to the ED. She had 2 days of light spotting preceding this sudden heavy bleeding, as well as irregular menses ever since a missed abortion 4 months prior. She had 2 electiv