Retained products of conception mimicking uterine arteriovenous malformation: A case report

Retained products of conception (RPOC) refer to the persistence of trophoblastic tissue within the uterine cavity following pregnancy. Highly vascular RPOC can mimic uterine arteriovenous malformations (AVMs), creating a diagnostic challenge, as dilation and curettage (D&C) regarded as the standard treatment for RPOC can pose a high risk of severe haemorrhage in AVM cases. Here, we report a case of a woman, second gravida with previous one normal vaginal delivery in her early twenties who presented with a history of on and off vaginal bleeding and abdominal pain 3.5 months after a spontaneous pregnancy loss which was managed with dilation and evacuation (D&E) outside. Initial medical management with mifepristone followed by misoprostol failed. Repeat Ultrasonography was suggestive of an arteriovenous malformation. Magnetic resonance imaging (MRI) identified an acquired AVM associated with RPOC type 3 that is RPOC with high vascularity involving the myometrium, complicating the treatment approach. Given the risk of haemorrhage, operative hysteroscopy was selected as a safer alternative to ‘blind’ D&C. This method allowed precise excision of the retained mass with minimal blood loss. Histopathological examination confirmed the diagnosis of RPOC.