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

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