[Rupture of an aneurism of the uterine artery during pregnancy treated by embolization]

Treatment of uterine artery (pseudo)aneurysm during pregnancy: A case report and review of the literature

PURPOSE

To describe the management of uterine artery (pseudo)aneurysm, ruptured or unruptured, during pregnancy.

METHODS

After reporting a case about this rare pathology, a review of the literature was performed. The search was applied to PubMed databases.

RESULTS

A total of eighteen articles met the inclusion criteria. Eighteen patients were reported. Eight (44.4 %) patients didn't have prior medical or surgical history. Fifteen (83.3 %) beneficed interventional radiology method during pregnancy including two cases (13.3 %) with repeated embolization because of recanalization of the (pseudo)aneurysm. Nine patients (50 %) beneficed a planned cesarean between 34 and 39 weeks of gestation. One (15.8 %) patient was diagnosed with fetal death before treatment of the uterine artery (pseudo)aneurysm.

CONCLUSION

The decision to proceed to the treatment of the (pseudo)aneurysm must consider several factors, associated or not with a good fetal vitality and a hemodynamically stable patient. Embolization appears to be the method of choice. Mode of delivery and term remain not clear and contraindication of expulsive efforts in case of a uterine artery (pseudo)aneurysm merit further investigations.

Embolization of a postcesarean pseudo-aneurysm of a uterine artery: A case report

Postpartum hemorrhage caused by a pseudoaneurysm of the uterine artery is suspected clinically in the case of abundant metrorrhagia. An ultrasound is performed, followed by further imaging modalities to confirm the diagnosis: CT scan, MRI, and angiography, the latter would also allow embolization. This is admittedly rare, however, since the pseudo aneurysm of the uterine artery is potentially fatal, it must be taken into account in the differential diagnosis of secondary postpartum hemorrhage, allowing adequate and rapid management. We report a case of pseudo aneurysm of the uterine artery, suspected clinically and confirmed by a CT scan, presenting as a secondary postpartum hemorrhage a few hours after delivery by cesarean section. It was eventually managed by embolization with excellent results several days after its onset when the cause was revealed. Angiographic embolization is an effective treatment for postpartum hemorrhage caused by pseudoaneurysm in stable patients. It should be considered before surgery in suitable cases.

Embolization of uterine artery pseudoaneurysm during pregnancy: case report and review of the literature

Objectives

Uterine artery pseudoaneurysm (UAP) is a rare but sinister complication during pregnancy. Diagnosis can be made by color Doppler ultrasound. Previous abdominal- and obstetric surgery increase the risk for UAP formation.

Case presentation

We present a case of a 36 year young healthy women, presenting at 27 weeks of gestation with acute lower abdominal pain. UAP was detected by color Doppler ultrasound. An endovascular coil embolization was performed, with good maternal and fetal outcome. Furthermore, a review of the literature looking at UAP embolization in pregnancy was performed.

Conclusions

UAP is reported to appear as a complication of endometriosis. UAP should be treated by endovascular coil embolization, which is a safe and with almost 100% success rate an effective treatment during pregnancy.

Uterine pseudoaneurysm on the basis of deep infiltrating endometriosis during pregnancy-a case report

Background

Pseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium. It is an uncommon condition that mainly occurs after traumatic injury to a vessel following pelvic surgical intervention, but also has been reported based on underlying endometriosis. There is an increased risk of developing UPA during pregnancy. Diagnosis includes clinical symptoms, with severe abdominal pain and is confirmed by sonographic or magnetic resonance imaging (MRI). Due to its potential risk of rupture, with a subsequent hypovolemic maternal shock and high fetal mortality, an interdisciplinary treatment should be considered expeditiously.

Case presentation

We present the case of a 34-year old pregnant symptomatic patient, where a large UPA was detected at 26 weeks, based on deep infiltrating endometriosis (DIE). The UPA was successfully treated by selective arterial embolization. After embolization, the pain decreased but the woman still required intravenous analgesics during follow-up. At 37 weeks she developed a sepsis from the intravenous catheter which led to a cesarean section and delivery of a healthy boy. She was discharged 10 days postpartum.

Conclusions

UPA should be considered in pregnant women with severe abdominal and pelvic pain, once other obstetrical factors have been excluded. DIE might be the underlying diagnosis. It is a rare but potentially life-threatening condition for mother and fetus.