Uterine arteriovenous malformation (AVM) is a rare lesion that cause postpartum hemorrhage .

AVM can be caused by trophoblastic disease , a history of pelvic surgery or curettage , also by cervical or endometrial malignancy . AVM can also be congenital . Clinical manifestation of AVM as a cause of postpartum hemorrhage : 1 . Severe vaginal bleeding secondary . 2 . Repeated episodes of bleeding due to the existence of secondary or tertiary HPP . 3 . Women with one or more blood transfusions . 4 . Bleeding is usually painless . 5 . There is a history of caesarean section or curettage . 6 .There is no evidence of other causes such as infection or the rest of the pregnancy on transvaginal sonography . AVM diagnosis is very difficult to be established . Standard diagnostic procedures such as pelvic examination , hysteroscopy and gray scale ultrasound has not been proven inadequate . The gold standard for diagnosis only with pelvic angiography . Embolization is a conservative option treatment. In this case , a hysterectomy selected as a definitive therapy, for in this patient the parity was enough and there is heavy bleeding . The patient had received three units of blood for hemodynamic stabilization .