Emergency embolization of uterine artery pseudoaneurysm after cesarean section
Kondrashin S.A., Koblikov V.V., Kovalev M.I.
Relevance: Uterine artery pseudoaneurysm is a rare and potentially life-threatening pathology of the arterial system. It can occur due to the damage to tissues during complicated vaginal delivery or cesarean section, uterine surgery, adnexal surgery (myomectomy, hysterectomy, metroplasty, cervicoplasty, perforation of the uterus during curettage or during diagnostic manipulations, removal of various tumors in the pelvic area, and others). This may be a rare cause of delayed postpartum hemorrhage in 3–6 cases per 1000 births.
Case report: A 25-year-old primigravida underwent an emergency cesarean section in the lower uterine segment due to an acute intrauterine fetal hypoxia at 40–41 weeks gestation. On the 4th day after surgery, she complained of an increase in body temperature to 37.5°C, nagging pains in the left iliac region. Doppler ultrasound imaging of the pelvic area to the left of the uterus revealed a pathological vascular formation in the parametrium. An emergency angiography of the pelvic vessels was performed, it was followed by embolization with two coils of the branches of the uterine artery feeding the pseudoaneurysm. Seven years after the operative delivery and embolization, the patient became pregnant and had a planned cesarean section at 40 weeks gestation without complications.
Conclusion: The first diagnostic method in an emergency situation is Doppler sonography. The method of choice in the treatment of uterine artery pseudoaneurysm is embolization of the feeding artery (provided there are conditions for such an operation).
Authors’ contributions: Kondrashin S.A., Kovalev M.I. – developing the concept and design of the study; Koblikov V.V. – collecting and processing the material; Kondrashin S.A., Koblikov V.V. – writing the text; Kondrashin S.A., Kovalev M.I. – editing the text.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of I.M. Sechenov First Moscow State Medical University (Sechenov University).
Patient Consent for Publication: The patient provided an informed consent for the publication of her data and associated images.
For citation: Kondrashin S.A., Koblikov V.V., Kovalev M.I.
Emergency embolization of uterine artery pseudoaneurysm after cesarean section.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (12): 213-218 (in Russian)
https://dx.doi.org/10.18565/aig.2023.116
Keywords
caesarean section
uterine artery pseudoaneurysm
Doppler sonography
uterine artery embolization
coils
long-term results
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Received 10.05.2023
Accepted 04.12.2023
About the Authors
Sergey A. Kondrashin, Dr. Med. Sci., Professor, Professor of the Department of Radiation Diagnostics and Radiation Therapy of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russian Federation, Moscow, Trubetskaya str., 8-2; Leading Researcher at the Department of X-ray Diagnostic, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecologyand Perinatology, Ministry of Health of the Russian Federation, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)609-14-00, kondrashin_s_a@staff.sechenov.ru,
https://orcid.org/0000-0002-3492-9446
Vasiliy V. Koblikov, Dr. Med. Sci., Assistant at the Department of Radiation Diagnostics and Radiation Therapy of the N.V. Sklifosovsky Institute of Clinical Medicine,
REDT doctor at the Department of X-ray surgical methods of diagnosis and treatment of University Clinical Hospital No. 1, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), https://orcid.org/ 0000-0002-9661-8686
Mikhail I. Kovalev, Dr. Med. Sci., Professor, Professor of the Department of Obstetrics and Gynecology No. 1 of the N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), https://orcid.org/ 0000-0002-0426-587X
Corresponding author: Sergey A. Kondrashin, kondrashin_s_a@staff.sechenov.ru
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