Selective Uterine Artery Embolization Research Articles

Selective uterine artery embolization is a valid adjuvant treatment of choriocarcinoma: a case report and literature review

BackgroundCervical choriocarcinoma is an extremely rare malignancy that is often misdiagnosed due to its nonspecific symptoms, such as vaginal bleeding.Case reportA 39-year-old female presented to the emergency department of the First Affiliated Hospital of Sun Yat-sen University with vaginal bleeding and a serum β-human chorionic gonadotropin (β-HCG) level of 229,386 mIU/mL. Initially, she was misdiagnosed with cervical pregnancy and subsequently underwent selective uterine artery embolization and cervical mass excision. However, pathological examination revealed the diagnosis of cervical choriocarcinoma.ConclusionThis case highlights the propensity for misdiagnosis of cervical choriocarcinoma. Selective uterine artery embolization proves to be an efficient measure to manage hemorrhage and potentially avoid unnecessary hysterectomy.

Successful pregnancy outcome following selective uterine artery embolization in a case of perforating gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia (GTN) includes a range of premalignant and malignant disorders of trophoblastic tissue. Invasive mole can present as a surgical emergency with rapidly progressive and highly vascular trophoblasts causing uterine perforation. Often hysterectomy is resorted to as a life-saving measure but in women desirous of future fertility, other options should be considered. We present the case of a nulliparous woman who presented with hemoperitoneum following perforating GTN. She was pale with stable vitals. Serum beta hCG at presentation was 98,156IU/L. Ultrasound pelvis revealed a highly vascular heterogenous hypoechoic mass of 5.8cm×5.5cm×6.5cm in the region of fundus and anterior myometrium showing significant internal and peripheral vascularity and displacing endometrium posteriorly. Ultrasound guided tap revealed hemoperitoneum. We decided for uterine artery embolization following clinical stabilization of the patient followed by chemotherapy. Figure 1 shows CT angiography done prior to uterine artery embolization. She conceived spontaneously two years later and was followed up closely in antenatal period. She was induced at 38 completed weeks due to oligohydramnios and decreased fetal movements and vaginally delivered a healthy baby with no postnatal complications. Fertility sparing procedures should be considered as a first possible option in selective cases. Multidisciplinary approach in high-risk cases is a key to optimal outcome.

Surgical evacuation combined with Shirodkar cervical suture and selective uterine artery embolization: A fertility preserving treatment for 10-15 weeks' live cesarean scar ectopic pregnancies.

Cesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. A retrospective single-center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown-rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables. Median CRL of the 17 patients included was 54.1 mm (range: 40.0-85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6-15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250-2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy. Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs.

Comparison of hysterectomy and uterine artery embolization in the treatment of symptomatic uterine fibroids: A protocol for systematic review and meta-analysis

Uterine fibroids are common benign tumors in premenopausal women. Surgery is the preferred treatment for symptomatic uterine fibroids. An alternative of hysterectomy to manage symptomatic uterine fibroids is selective uterine artery embolization. We performed a protocol for systematic review and meta-analysis to assess the effectiveness of uterine artery embolization for treating symptomatic uterine fibroids compared with hysterectomy. The current systematic review and meta-analysis will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. This review protocol has been registered in the International Prospective Register of systematic reviews. Its registration number is CRD42022371866. Only randomized controlled trials (RCTs) are included in our study.Two independent reviewers will search for databases including PubMed, Embase, Cochrane Library website, ClinicalTrials.gov databases, Chinese National Knowledge Infrastructure Database, Wanfang database, and VIP database. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The RevMan 5.3 software (Cochrane Collaboration, Oxford, UK) will be used to conduct the meta-analyses. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will provide high quality evidence to judge whether uterine artery embolization is an effective surgical method for patients with symptomatic uterine fibroids.

8731 Combined Preserving Fertility Treatment of Women with Cervical Pregnancy

Study Objective To evaluate the effectiveness of combined approaches for preserving fertility in patients with cervical/cesarean scar pregnancy. Design Canadian Task Force Level II Study. Setting Operative Gynecology department, National Medical Research Centre for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russia. Patients or Participants 105 cases of cervical pregnancy were treated at Operative Gynecology department over the period of 15 years. Interventions 35 of 89 women with cervical pregnancy required combined therapy with preoperative methotrexate chemotherapy and resectoscopy; 3 patients had abdominal hysterectomy. Resectosopy included evacuation of embrio, curettage of the uterine cavity and cervical canal, resectoscopic coagulation of cervical vessels, ligation of the descending branches of the uterine arteries (as needed). In 33 cases with highest blood supply of chorion and its invasion into the cervix, we added bilateral selective uterine artery embolization (SUAE). Parameters for each approach were established. Measurements and Main Results The gestational age ranged from 5 to 10 weeks. Patients with cervical pregnancy received methotrexate at an average of 50 mg/every 48 hours, leucovorin administered at a dose of 6 mg after 28 hours after methotrexate injection. The total dose of administered methotrexate was 200 to 300 mg. Surgical procedure started at decreased level of β-hCG about 4000-7000 IU/l. The blood loss in all cases after SUAE was less than 30 cc. The effectiveness of organ-spearing treatment of cervical pregnancy is 96.63% and 100% in cesarean scar pregnancy. Conclusion The results of our study suggest that resectoscopic removal of embryo preceded by cytostatic therapy with methotrexate and leucovorin allows to preserve fertility in women with early cervical pregnancy. In cases of chorion invasion into the cervix and myometrium SUAE following resectoscopy appears to be a treatment of choice. To evaluate the effectiveness of combined approaches for preserving fertility in patients with cervical/cesarean scar pregnancy. Canadian Task Force Level II Study. Operative Gynecology department, National Medical Research Centre for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russia. 105 cases of cervical pregnancy were treated at Operative Gynecology department over the period of 15 years. 35 of 89 women with cervical pregnancy required combined therapy with preoperative methotrexate chemotherapy and resectoscopy; 3 patients had abdominal hysterectomy. Resectosopy included evacuation of embrio, curettage of the uterine cavity and cervical canal, resectoscopic coagulation of cervical vessels, ligation of the descending branches of the uterine arteries (as needed). In 33 cases with highest blood supply of chorion and its invasion into the cervix, we added bilateral selective uterine artery embolization (SUAE). Parameters for each approach were established. The gestational age ranged from 5 to 10 weeks. Patients with cervical pregnancy received methotrexate at an average of 50 mg/every 48 hours, leucovorin administered at a dose of 6 mg after 28 hours after methotrexate injection. The total dose of administered methotrexate was 200 to 300 mg. Surgical procedure started at decreased level of β-hCG about 4000-7000 IU/l. The blood loss in all cases after SUAE was less than 30 cc. The effectiveness of organ-spearing treatment of cervical pregnancy is 96.63% and 100% in cesarean scar pregnancy. The results of our study suggest that resectoscopic removal of embryo preceded by cytostatic therapy with methotrexate and leucovorin allows to preserve fertility in women with early cervical pregnancy.

Hysteroscopic resection vs dilation and evacuation for treatment of caesarean scar pregnancy: study protocol for a randomised controlled trial.

Caesarean scar pregnancy (CSP) is a type of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section. Management options for women who opted for termination of CSP include sharp curettage, dilation and evacuation (D&E), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolisation with curettage and/or methotrexate administration. Recently hysteroscopic resection has also been proposed as an alternative option. To compare the surgical outcome of hysteroscopic resection with dilation and evacuation (D&E) for the treatment of caesarean scar pregnancy (CSP). Parallel-group, non-blinded, randomised clinical trial conducted at a single centre in Italy. Eligible women are those with singleton gestations at less than 9 weeks of gestation, and with thickness of myometrial layer ≥1 mm at the level of the ectopic. Inclusion criteria are women with CSP with positive embryonic/fetal heart activity who opted for termination of pregnancy. Patients will be randomised 1:1 to receive either hysteroscopic resection (i.e. intervention group) or D&E (i.e. control group). In both groups, 50 mg/m2 (based on DuBois formula for body surface area) of methotrexate (MTX) will be injected intramuscularly at the time of randomisation (day 1) and another dose at day 3. A third dose of MTX is planned in case of persistence of fetal heart activity on day 5. Participants will receive either D&E or hysteroscopic resection from 3 to 7 days after the last dose of MTX. A sample size of 54 women is planned. The primary outcome is the success rate of the treatment protocol, defined as no requirement for further treatment until complete resolution of the CSP as demonstrated by negative beta hCG levels and absence of residual gestational material on ultrasound examination.. Hysteroscopic surgery is superior to D&E for the treatment of CSP. The results of the trial will provide information on the best treatment for CSP.

Uterine artery pseudoaneurysm after treatment of cesarean scar pregnancy: a case report

BackgroundPseudoaneurysms are formed when a local arterial wall ruptures, leading to hemorrhage and hematoma adjacent to the artery. Continuous perfusion of the injured artery increases the pressure in the lumen of the pseudoaneurysm. It may rupture and lead to massive hemorrhage that could be life-threatening. Cesarean scar pregnancy (CSP) is an ectopic pregnancy where the gestational sac is implanted in the cesarean scar. Uterine artery pseudoaneurysm (UAP) after CSP treatment is rare.Case presentationWe report the case of a 36-year-old Chinese woman who presented with acute massive vaginal bleeding 53 days after transabdominal scar pregnancy excision. Doppler ultrasound confirmed UAP. Selective uterine artery embolization (UAE) failed because of the thin and curved blood vessels. The lesion decreased in size after transvaginal ultrasound-guided direct thrombin injection (UGTI); however, massive vaginal bleeding recurred and endangered the patient’s life. The uterus was removed thereafter.ConclusionsUAP is a rare complication after CSP treatment that can lead to fatal massive hemorrhage. Ultrasound should be reexamined regularly after treatment of CSP. In case of unexplained vaginal bleeding, we should be alert to the existence of UAP and the possibility of rupture and take effective diagnosis and treatment measures promptly.

Combined Minimally Invasive Approach to Preserving Fertility in Patients with Cervical Pregnancy

Study Objective Assess the feasibility of the minimally invasive methods in preserving the fertility in patients with cervical pregnancy. Design Canadian Task Force: Level II-2 Prospective and retrospective analysis. Setting Department of Operative Gynecology, V.I Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation; Moscow, Russian Federation. Patients or Participants 66 women with cervical pregnancies desiring preservation of fertility (ages 25-44 years), treated at the Department of Operative Gynecology during the past 13 years. Interventions Standard diagnostic clinical protocol was carried out in all patients. Patients with cervical pregnancy received intravenous methotrexate at an average of 50 mg/every 48 hours and 6 mg of intramuscular leucovorin rescue injection at 28 hours after methotrexate administration followed by resectoscopy or combined selective uterine embolization and resectoscopic approach. 2 women with massive bleeding on admission required hysterectomy. Measurements and Main Results The gestational age on admission ranged from 5 to 11 weeks with mean gestational age being 6.8 ± 0.8 weeks. 64 women underwent combined therapy with preoperative systemic methotrexate and resectoscopic excision. 28 of these patients had chorionic invasion into the cervix and required selective uterine artery embolization (SUAE), followed by resectoscopy. 2 patients with massive bleeding underwent emergent hysterectomy. Uterus preserving surgical procedures were started when a decreasing levels of β-hCG of 4000-7000I U/l were demonstrated. Bilateral SUAE was utilized in 28 cases, through the right femoral approach (12 cases) and through the right radial artery (16). The blood loss in all cases was less than 25 cc, including the ones with chorionic invasion. Conclusion The results of our study suggest that resectoscopic removal of embryos with previous cytostatic therapy with methotrexate allows for the preservation of fertility in young women with early cervical pregnancy. SUAE provides minimal operative blood loss and shorter hospital stay, and preserves reproductive potential in women with chorionic cervical invasion.

Interventional Treatment of Symptomatic Uterine Fibroid by Uterine Artery Embolisation at the University Teaching Hospital in Lusaka, Zambia

Objective: To investigate the clinical effect of interventional therapy for symptomatic uterine fibroid by transcatheter uterine artery embolisation.
 Methods: Sixteen patients of symptomatic uterine fibroids were treated with selective uterine artery embolisation, and the relief of symptoms and reduction of fibroids were observed.
 Results: Bilateral uterine artery embolisation was done in 16 patients. Follow-up for 5 ~ 7 months showed that the clinical symptoms of 14 patients were obviously improved, and the re-examination of 1 patient of a very large myoma showed no obvious change after 6 months. B-Ultrasound showed that the size of the tumor was reduced by 43% ~ 92%. The major complication was being is postoperative lower abdominal pain.
 Conclusion: Uterine artery embolisation is a safe and effective method to treat uterine fibroid.

Interventional Treatment of Symptomatic Uterine Fibroid by Uterine Artery Embolisation at the University Teaching Hospital in Lusaka, Zambia

Abstract
 Purpose: To investigate the clinical effect of interventional therapy for symptomatic uterine fibroid by transcatheter uterine artery embolization.
 Methods: 16 patients of symptomatic uterine fibroids were treated with selective uterine artery embolization, and the relief of symptoms and reduction of fibroids were observed.
 Results: Bilateral uterine artery embolization was done in 16 patients. Follow-up for 5 ~ 7 months showed that the clinical symptoms of 14 patients were obviously improved, and the reexamination of 1 patient of a super large myoma showed no obvious change after 6 months. B-Ultrasound showed that the size of the tumor was reduced by 43% ~ 92%. The major complication was being is postoperative lower abdominal pain.
 Conclusion: Uterine artery embolization is a safe and effective method to treat uterine fibroid.

Three-dimensional color Doppler before and after embolization of postpartum-acquired enhanced myometrial vascularity/arteriovenous malformation

The figures illustrate a case of a woman with acquired enhanced myometrial vascularity/arteriovenous malformation after vaginal delivery. The woman had a secondary postpartum hemorrhage 25 days after delivery and underwent bilateral selective uterine artery embolization. She had a history of hysteroscopic resection of a uterine septum. Figure 1 shows transvaginal three-dimensional (3D) ultrasound with color Doppler of the lesion before (solid arrow) and after (dotted arrow) uterine artery embolization.

Clinical efficacy analysis of selective uterine artery embolization in the treatment of obstetrical hemorrhage.

Clinical efficacy analysis of selective uterine artery embolization in the treatment of obstetrical hemorrhage.

Uterine artery embolization in obstetrics

Introduction. We did not find any publications or mentions in the Ukrainian medical segment of the Internet and special medical literature about previously performed similar operations (simultaneous caesarean section and embolization of the uterine arteries directly at the moment of birth), which allows us to consider the two operations performed «Prophylactic selective transcatheter embolization of uterine arteries» in pa­­tients with placenta previa percreta the first in Ukraine. Background. The prevalence of placenta previa and placenta percretaincreases from year to year as a result of an increase in the number of cesarean sections. Because of this, the percentage of women at high risk of massive life-threatening bleeding is also increasing. Predictions around the world show that the incidence of cesarean section will increase, which will lead to an increase in the number of placenta previa and placenta increta and thereafter maternal mortality, since the main cause of maternal mortality is bleeding (about 35 % of cases). The aim study was to asses of the effect of preventi­­ve selective embolization of uterine arteries with placenta previa percreta on the volume of blood loss during delivery, and the possibility of preserving the uterus and the reproductive function of women. Material and methods. In 2018—2019, we per­­formed two prophylactic selective transcatheter em­­bolizations of the uterine arteries in patients with placenta previa percreta. The delivery of these patients took place in the form of simultaneous endovascular embolization of the uterine arteries during cesarean section. The delivery algorithm was as follows: the first stage was the contralateral catheterization of the uterine arteries by transfemoral access. Next, corporal cae­sarean section was performed. After extraction of the fetus and clamping of the umbilical cord, uterine arteries were selectively embolized until the blood flow through them was completely stopped. Then, sepa­­ration/dissection of the placenta, metroplasty and suturing of the wound were performed. At the end of the operation, catheters from the uterine arteries were removed. Results and discussion. The entire embolization procedure (in total: from puncture of the femoral arteries to control angiography after embolization) took 27 minutes in the first case and 38 minutes in the second. The longer embolization time in the second case is partially associated with unilateral access and alternate catheterization of the uterine arteries. This was done to minimize post-procedural complications of the site of puncture of the femoral artery. Unfortunately, the technical conditions for these embolizations did not allow transradial access, which is possible from a practical point of view. The postpartum period was without complications. As the experience of these two operations showed, it was not possible to achieve the fullness of the «dry uterus» by embolization of the uterine arteries, but the volume of blood loss taking into account reinfusion in the form of washed red blood cells turned out to be lower than the median values of most cases and published studies described in foreign literature. Conclusions. Preventive selective transcatheter em­­bo­­lization of the uterine arteries before birth/removal of the placenta can be considered as a good preventi­­on of primary postpartum hemorrhage and thus to provide organ rescue. In pregnant women of high-risk groups, it is better to carry out catheterization of the uterine arteries in a planned manner before delivery, simultaneously with cesarean section, which is technically simpler.

The utility of Doppler ultrasonography in diagnosis of delayed postpartum hemorrhage: a case report

Although uncommon, delayed postpartum hemorrhage (PPH) can be caused by uterine arteriovenous malformation (AVM), which can lead to severe mortality and morbidity in the mother. Therefore, accurate diagnosis and rapid treatment of uterine AVM may have a significant impact on a patient’s prognosis. In the present case, the patient had vaginal bleeding two weeks after the cesarean section and was referred to the present hospital. She was diagnosed quickly with AVM by Doppler ultrasonography and treated with selective uterine artery embolization leading to a full recovery. Here the authors report the usefulness of Doppler ultrasound for early diagnosis of uterine AVM causing delayed PPH in the light of this case.

Delayed surgical and non-surgical treatment of placental remnants: no difference was found in the clinical efficacy and long-term pregnancy outcomes

PurposeIn a tertiary hospital, patients facing delayed treatment with placental remnants were common. The aim of this study was to assess the clinical efficacy and long-term pregnancy outcomes of the delayed surgical/non-surgical treatment for placental remnants.Patients and methodsThe records of referral patients with placental remnants after second/third-trimester delivery/termination of pregnancy were retrospectively analyzed. A long-term follow-up was made by phone to inquire about the future pregnancy outcomes. The measurements of clinical efficacy included the postpartum intervals for Doppler ultrasound to become normal and for menstrual cycle to return to normal. Conception rate, interval for future pregnancy and obstetric outcomes were used to assess future pregnancies.ResultsA total of 65 patients, who were clinically diagnosed with placental remnants after termination of pregnancy at the second or third trimester from 2000 to 2016, were included in this study. Delayed surgical treatments employed at a median interval (MI) of 2.7 months after termination of pregnancy had a similar interval for ultrasound (P=0.353) and menstrual cycle (P=0.751) to return to normal compared with non-surgical treatments. For non-lactating patients who accepted expectant treatments, the postpartum interval for ultrasound to return to normal was significantly longer than that for menstrual cycle to become normal (MI=3.6, 1.5 months, respectively, P=0.000). For all of the patients successfully treated, the conception rate (P=1.00), the interval for a second pregnancy (P=0.771), ongoing-pregnancy/live birth rate (P=0.419) and the recurrence rate of placenta accrete (P=1.00) there was no significant difference between non-surgical and surgical treatments. Assisted selective uterine artery embolization at an MI of 23 days after the termination of pregnancy had a longer interval for ultrasound to become normal than single expectant treatment (P=0.017). For all patients after expectant treatments, 94.1% of patients conceived after an MI of 12.5 months with the ongoing-pregnancy/live birth rate of 66.7% and a 33.3% recurrence rate of placenta accreta.ConclusionAccording to our experience, delayed surgeries at a postpartum interval of 2.7 months might have similar clinical efficacy and long-term pregnancy outcomes with expectant treatment in treating placental remnants.

Selective Uterine Artery Embolization: An Effective Treatment Option for Postpartum Hemorrhage due to Pseudoaneurysm of Uterine Artery

ABSTRACT Aim To demonstrate the efficacy of uterine artery embolization in the management of postpartum hemorrhage (PPH) due to pseudoaneurysm of the uterine artery. Background Postpartum hemorrhage is a leading cause of maternal mortality in India. Secondary PPH is a rare cause but potentially life threatening. Common causes of secondary PPH are retained products of conception, subinvolution of uterus, and endometritis. Pseudoaneurysm is an uncommon cause of secondary PPH following operative delivery. Color Doppler ultrasound is a useful diagnostic tool and angiography is necessary to localize and treat by embolization. Case report We report two cases of secondary PPH due to pseudoaneurysm of uterine artery, which were managed by selective embolization of uterine artery. Conclusion Angiographic embolization of uterine artery is a safe and reliable technique for management of secondary PPH due to pseudoaneurysm. If diagnosed early, the need for hysterectomy is prevented. Clinical significance Uterine artery embolization has emerged as a simple, effective, and fertility-sparing treatment for PPH. How to cite this article Gollapudi R, Rammurty S. Selective Uterine Artery Embolization: An Effective Treatment Option for Postpartum Hemorrhage due to Pseudoaneurysm of Uterine Artery. J South Asian Feder Obst Gynae 2017;9(3):283-286.

Uterine Arteriovenous Malformation: A Rare Cause of Secondary Postpartum Hemorrhage

Ruptured uterine arteriovenous malformation (AVM) such as uterine artery pseudoaneurysm is an extremely rare cause of secondary postpartum hemorrhage (PPH), thus causing a diagnostic and therapeutic dilemma for the managing obstetricians. We describe a case of a 40-year-old lady who presented with recurrent intractable secondary PPH unresponsive to conventional treatment following an emergency lower segment cesarean section (LSCS). This was her second LSCS for a failed trial of vaginal birth after cesarean section (VBAC). Subsequently left uterine artery extravasation was identified on pelvic angiogram and selective embolization was done with successful treatment of her PPH. To date, there have been only case reports or case series available on literature due to its rarity of the diagnosis. We wish to raise awareness of this rare diagnosis in patients with risk factors as a cause of recurrent PPH not responding to medical management. We also wish to share our experience with the successful use of selective uterine artery embolization for the management of this condition which resulted in avoidance of hysterectomy and its associated morbidity. J Med Cases. 2017;8(5):152-154 doi: https://doi.org/10.14740/jmc2804w

Uterine Arteriovenous Malformation: A Rare Cause of Secondary Postpartum Hemorrhage

Ruptured uterine arteriovenous malformation (AVM) such as uterine artery pseudoaneurysm is an extremely rare cause of secondary postpartum hemorrhage (PPH), thus causing a diagnostic and therapeutic dilemma for the managing obstetricians. We describe a case of a 40-year-old lady who presented with recurrent intractable secondary PPH unresponsive to conventional treatment following an emergency lower segment cesarean section (LSCS). This was her second LSCS for a failed trial of vaginal birth after cesarean section (VBAC). Subsequently left uterine artery extravasation was identified on pelvic angiogram and selective embolization was done with successful treatment of her PPH. To date, there have been only case reports or case series available on literature due to its rarity of the diagnosis. We wish to raise awareness of this rare diagnosis in patients with risk factors as a cause of recurrent PPH not responding to medical management. We also wish to share our experience with the successful use of selective uterine artery embolization for the management of this condition which resulted in avoidance of hysterectomy and its associated morbidity. J Med Cases. 2017;8(5):152-154 doi: https://doi.org/10.14740/jmc2804w

Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment.

To report our clinical practice regarding a case series of retained products of conception (RPOC) with marked vascularity (MV) managed with selective uterine artery embolization (UAE) as first-line treatment. This was a monocentric, retrospective study of 31 consecutive cases of RPOC with MV diagnosed by Doppler ultrasound in the context of postpartum/postabortal bleeding. The primary outcome was the absence of rebleeding following embolization. RPOC with MV occurred after abortion in 27 out of 31 patients (87%). The time elapsed between delivery/abortion and UAE ranged from 1 to 210days (mean 55.7±45days). Primary clinical success was achieved in 23 women (74.2%) following a single embolization. In total, 27 out of 31 women (87%) had been exclusively managed by UAE with conservative success. Although procedural success was achieved in this number, six women had a further procedure to evacuate RPOC despite procedural success. Large uterine arteriovenous (AV) shunts associated with RPOC were observed in five cases (16.1%), among which two were successfully treated after a single UAE and one after two UAEs, while hysterectomy was performed in the last two cases despite two and three UAE procedures respectively. RPOC was histologically proven in ten cases (32.2%) including four out of five cases of uterine AV shunt. RPOC with MV can present with large uterine AV shunt, particularly in case of late management. Uterine artery embolization is an effective and safe first-line treatment, and should be evaluated for this indication in larger prospective trials.

Uterine artery embolization in cervical pregnancy - alternative to total hysterectomy

In article experience of use of endovascular embolization of uterine arteries in treatment of cervical pregnancy is described. Super selective uterine artery embolization followed by removal of the ovum devascularization held 7 patients aged 27,8 ± 2,2 years with cervical pregnancy in terms of 5 and 7 weeks. After the reduction of level of chorionic gonadotropin, and in the absence of blood-groove in the fetal ovum, its evacuation was carried out under the control arteriography. Blood loss during the operation does not exceed 100 ml. Postoperative period lasted 4,6 ± 0,4 days. Thus, uterine artery embolization is effective method of complex treatment with cervical pregnancy thus reducing the risk of bleeding and to keep the reproductive function at young women.