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Arteriovenous malformation as a cause for acute confusion and gastrointestinal bleeding in a primigravida pregnancy
  1. Helen Clarke1,
  2. Thomas McCormack1,
  3. Emila Paul2 and
  4. Jonathan Ford1
  1. 1Obstetrics and Gynaecology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
  2. 2General Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
  1. Correspondence to Jonathan Ford;{at}


Acute confusion in pregnancy is generally uncommon, given the relatively young and healthy population obstetricians care for. We present an unusual and rare case of acute confusion in a term pregnancy with antecedent history of gastrointestinal (GI) bleeding. A primigravida with no medical history of note, was found to have a haemoglobin of 67 g/L at booking and was commenced on oral iron supplementation. In the third trimester, she presented with haematochezia and had several admissions, requiring 18 units of red blood cells during her pregnancy. At term, she was admitted with acute confusion and GI bleeding, and was subsequently delivered by caesarean section to facilitate ongoing investigation and management of her symptoms. She was diagnosed postnatally with an arteriovenous malformation in the jejunum which required interventional radiology and surgical management for symptom resolution. Her confusion was attributed to hyperammonaemic levels secondary to her high protein load.

  • pregnancy
  • gastrointestinal surgery
  • GI bleeding
  • haematology (incl blood transfusion)

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  • Contributors All authors participated in the patient's care. TM and EP provided draft submissions which were integrated into the final draft. The final draft was complied and written by HC, overseen by JF. All authors reviewed the draft manuscript and suggested changes which were implemented by HC. The final draft was approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.