Massive maternal haemorrhage due to a mandibular arteriovenous malformation in a term pregnancy: A case report

Mandibular arteriovenous malformations (AVMs) are vascular lesions that are rare in pregnancy but that can be life threatening due to the potential for massive haemorrhage when ruptured. This report describes a 30-year-old woman who presented at 39 weeks of gestation with hypovolemic shock secondary to a massive haemorrhage from her oral cavity. After resuscitation, she underwent an emergency caesarean section indicated for fetal distress. A live infant was born who required neonatal intensive care support. An angiogram was performed post-operatively which demonstrated a mandibular AVM that was selectively embolised. The patient and her newborn ultimately recovered with no further bleeding or complications. This report describes the fourth case of a mandibular AVM in pregnancy published in the literature, that was managed with selective embolisation. More research is required to determine the effect of pregnancy on AVM manifestation and rupture. Antenatal management should be on a case-by-case basis with multi-disciplinary team involvement.