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

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 underly...

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Bibliographic Details
Published in:BMC pregnancy and childbirth 2021-04, Vol.21 (1), p.282-282, Article 282
Main Authors: Zwimpfer, Tibor Andrea, Monod, Cécile, Redling, Katharina, Willi, Heike, Takes, Martin, Fellmann-Fischer, Bernhard, Manegold-Brauer, Gwendolin, Hösli, Irene
Format: Article
Language:English
Subjects:
Abdomen
Cardiac arrhythmia
Case Report
Case reports
Cesarean section
Deep infiltrating endometriosis
Embolization
Endometriosis
Fetuses
Gestational age
Interdisciplinary aspects
Laboratories
Ovaries
Pain
Pregnancy
Pseudoaneurysm
Ultrasonic imaging
Uterine pseudoaneurysm
Veins & arteries
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Summary: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. 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. 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.
ISSN:1471-2393
1471-2393
DOI:10.1186/s12884-021-03753-1