Multiple and massive arteriovenous malformations in pregnancy.

Arteriovenous malformations (AVM) are rare in the reproductive years of life. There is a paucity of data regarding AVMs in pregnancy. Pregnancy can influence both the development and the progression of AVMs. The tendency to bleed is unpredictable. Many AVMs undergo spontaneous postpartum regression. We report on a 30-year old primipara with multiple generalised AVMs, both congenital and acquired, and a massive congenital AVM involving her entire right upper limb and shoulder girdle. Magnetic resonance imaging suggested there were AVMs in both the pelvis and the lower abdominal wall. The main management dilemma was mode of delivery. A trial of vaginal delivery was successful after spontaneous onset at term. The patient had a series of significant postpartum haemorrhages, warranting blood transfusion.