Acute Ovarian Insufficiency and Uterine Infarction Following Uterine Artery Embolization for Postpartum Hemorrhage.

Sarah Z Elsarrag

doi:10.23937/2378-3656/1410040

Abstract

Uterine artery embolization for intractable postpartum hemorrhage saves lives while preserving fertility. The procedure-related risks of uterine infarction and ovarian insufficiency are rare. A primparous patient underwent bilateral internal hypogastric artery embolization to control severe postpartum hemorrhage following primary cesarean section. The bleeding continued, and a repeat aortogram demonstrated significant filling of the uterus from an anomalous proximal take off of the right uterine artery and from the left ovarian artery. Further embolization was required to control the bleeding. The patient developed acute primary ovarian insufficiency within two weeks of the procedure and subsequently presented with uterine infarction necessitating hysterectomy. This case demonstrates the increased risk of acute ovarian insufficiency and uterine infarction following uterine artery embolization for postpartum hemorrhage in the settings of aberrant pelvic vasculature.

Highlights

Uterine artery embolization (UAE) for intractable postpartum hemorrhage (PPH) saves lives while preserving fertility [1,2]
Inadvertent ovarian artery embolization leading to ovarian failure following UAE for PPH has, been described [16]
A randomized comparison measuring AMH levels following UAE for fibroids indicated that AMH level, which is a measure of ovarian reserve, is decreased when compared to surgical hysterectomy [16,17]

Summary

Introduction

Uterine artery embolization (UAE) for intractable postpartum hemorrhage (PPH) saves lives while preserving fertility [1,2]. Two cases of fatal sepsis following UAE for uterine fibroids have been reported [3,4]. Inadvertent ovarian artery embolization leading to ovarian failure following UAE for PPH has, been described [16]. Others have reported that UAE does not appear to impair fertility when treating fibroids for women of childbearing age, but women older than 45 years of age are at increased risk for permanent ovarian failure due to their already decreased ovarian reserve [18,19]. We report a case of acute ovarian insufficiency occurring within two weeks of UAE for PPH, most likely due to anomalous pelvic vasculature with large uterineovarian arteries anastomosis. While variations in pelvic vasculature have been described [20], they have not been reported in association with acute ovarian insufficiency

Materials and Methods

Discussion