Background We present a rare case of arteriovenous malformation of the vulva

Case A woman presented at 28 weeks gestation with recurrent episodes of antepartum haemorrhage seen on her clothes. On pelvic examination, there was no evidence of bleeding and the vagina and cervix were found to be completely normal. Multiple examinations by different doctors over 48 h revealed no source of bleeding. A large episode of painless active bleeding of approximately 500ml of blood prompted a decision to proceed to caesarean section as blood was pooling within the vagina. Following spinal anaesthetic and reassessment, a pulsatile 3 × 3mm vulval lesion was seen “spurting” blood and was excised. A caesarean section was not carried out. Histology confirmed an arteriovenous malformation.

Discussion Vulval Arteriovenous malformations are very rare and only a handful of cases have been presented in the literature. Due to their rarity and atypical presentation, diagnosis can be very difficult and easily missed, especially when complicated by pregnancy. This case clearly demonstrates this.