A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

Yoshikawa, Midori; Seyama, Takahiro; Iriyama, Takayuki; Sayama, Seisuke; Fujii, Tatsuya; Toshimitsu, Masatake; Nakaya, Misako; Kurokawa, Ryo; Shibata, Eisuke; Watadani, Takeyuki; Kumasawa, Keiichi; Nagamatsu, Takeshi; Koga, Kaori; Osuga, Yutaka

doi:10.1155/2022/2859766

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…It presents with complaints such as abdominal or pelvic pain, abdominal distension, fever, metrorrhagia, and vaginal discharge. [26][27][28] It can be diagnosed on ultrasound, wherein the myometrium shows no internal vascularity on colour Doppler, as well as on CT, where the myometrium shows lack of enhancement in post-contrast sequences. Although rarely used, an MRI may also confirm the findings of myometrial necrosis.…”

Section: Discussionmentioning

confidence: 99%

Imaging Features of Myometrial Necrosis in a Patient Due to Uterine Compression Sutures

Badhe,

Varrior,

Sultan

et al. 2024

EMJ Radiol

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Postpartum haemorrhage (PPH) is a significant cause of maternal morbidity and mortality. The management includes a spectrum ranging from mechanical and pharmacological to surgical methods. The authors report a case of a 24-year-old primigravida who presented with complaints of abdominal pain, distension, fever, and diarrhoea a few days after her delivery. She had postpartum haemorrhage, for which compression sutures were applied. On radiological investigations, she was diagnosed with myometrial necrosis, following which she underwent a subtotal hysterectomy. Myometrial necrosis is a common complication encountered in the setting of postpartum haemorrhage secondary to compressive sutures. An early diagnosis and an appropriate management requires adequate radiological investigations.

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Section: Discussionmentioning

confidence: 99%

Imaging Features of Myometrial Necrosis in a Patient Due to Uterine Compression Sutures

Badhe,

Varrior,

Sultan

et al. 2024

EMJ Radiol

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“…Our patient was of a young age, received prophylactic antibiotics, and remained hemodynamically stable. There have been reports of possible association of uterine necrosis with hypertensive disorders of pregnancy such as pre-eclampsia, especially due to uterine local circulatory failure associated with intravascular volume depletion [ 10 ] [ 11 ]. The patient in this case did not have this particular risk factor.…”

Section: Discussionmentioning

confidence: 99%

Hysterectomy Sparing Management of Uterine Necrosis following Uterine Artery Embolization for Postpartum Hemorrhage

Chlela,

Dawkins,

Lewis

2023

Case Reports in Obstetrics and Gynecology

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Background. Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality. Uterine artery embolization (UAE) is an effective procedural intervention for controlling PPH. Uterine necrosis (UN) is a rare complication of UAE and its management usually results in hysterectomy. We highlight a case of UAE complicated by UN managed conservatively without hysterectomy. Case. This is the case of a 30-year-old patient who had a cesarean section delivery and subsequently developed PPH due to uterine atony. The estimated blood loss (EBL) was 2500 ml; despite the use of uterotonic medications and trial of intrauterine balloon tamponade. She successfully underwent a UAE with no immediate complications. The remainder of her postnatal course was uncomplicated, and she was discharged on postoperative day 4. On postoperative day 28, the patient presented with fever, vaginal discharge, and abdominal pain. An abdomino-pelvic computed tomography scan revealed areas of necrosis within the uterus secondary to recent UAE. After minimal clinical improvement, the patient underwent a dilation and curettage with ultrasound guidance. The patient improved clinically and was discharged home to complete a 14-day course of antibiotics. Conclusion. UAE is an important minimally invasive approach to the management of PPH. UN following UAE can present a clinical challenge to physicians, with the underlying pathophysiology being use of small embolizing particles during UAE and lack of arterial collaterals to embolized areas. A total of 19 cases of UN post-UAE have been described of which most of these cases were managed with a hysterectomy. In this case, an alternative treatment plan was successfully implemented via dilation and curettage under ultrasound guidance for removal of organized necrotic tissue. This was sufficient to improve the patient’s symptoms and clinical outcome and saved the patient from the morbidity and mortality risks associated with a hysterectomy.

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Uterine necrosis following uterine artery embolization as treatment for postpartum hemorrhage: A case report and literature review

Yin,

Liu,

2024

Intl J Gynecology & Obste

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Uterine necrosis is a rare complication of uterine artery embolization for postpartum hemorrhage and most patients end up having a hysterectomy. Here we report a case in which the patient experienced a recurrent fever 28 days after uterine artery embolization as treatment for postpartum hemorrhage and had no response to antibiotics. Magnetic resonance imaging of the pelvis revealed a mass which was approximately 12‐cm in size with air bubbles in the uterus, suggesting necrosis with infection. Transvaginal clamping of the uterine mass was performed and necrotic tissue removed under laparoscopic monitoring, which successfully spared the necessity for a hysterectomy. The patient's subsequent progress was favorable. In the present study we review the high‐risk factors of uterine necrosis following uterine artery embolization and summarize the key points of early diagnosis. In addition, we propose a strategy to successfully spare the necessity for a hysterectomy without the spread of infection or uterine perforation.

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A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

Cited by 4 publications

References 12 publications

Imaging Features of Myometrial Necrosis in a Patient Due to Uterine Compression Sutures

Imaging Features of Myometrial Necrosis in a Patient Due to Uterine Compression Sutures

Hysterectomy Sparing Management of Uterine Necrosis following Uterine Artery Embolization for Postpartum Hemorrhage

Uterine necrosis following uterine artery embolization as treatment for postpartum hemorrhage: A case report and literature review

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