Assessment of extravasation on ruptured uterine artery pseudoaneurysm using contrast-enhanced ultrasonography during uterine balloon tamponade

Abstract

Objective Contrast-enhanced ultrasonography (CEU) has been used in critical trauma situations to visualize extravasation; however, its use is limited in the field of obstetrics. Cases of ruptured uterine artery pseudoaneurysm (UAP) were analyzed to clarify the efficacy to CEU during uterine balloon tamponade. Methods Cases of ruptured UAP diagnosed at a teaching university hospital from January 2015 to December 2017 were retrospectively analyzed. UAP was diagnosed using color Doppler ultrasonography. Extravasation was identified using computed tomography and double checked using CEU with an intravenously administered contrast agent (Sonazoid; Daiichi Sankyo Company, Ltd., Tokyo, Japan) and an ultrasound instrument (HI VISION Preirus; Hitachi Aloka Medical, Ltd., Tokyo, Japan). A balloon was then inserted into the uterine cavity and inflated at the point of bleeding until extravasation ceased. Results Three patients exhibited ruptured UAP during the study period. Bleeding points were successfully identified using CEU in all cases, and hemostasis was achieved using uterine balloon tamponade. Obliteration of UAP was confirmed using magnetic resonance imaging, and no patients developed recurrent UAP or any complications. Conclusion CEU can be used at the bedside to promptly diagnose ruptured UAP. Moreover, it precisely facilitates balloon compression at the point of bleeding.

Advantages of contrast-enhanced ultrasonography and uterine balloon tamponade during intrauterine evacuation of retained products of conception

“…We also reported cases of UBT using ultrasound contrast agents for pseudoaneurysms. 17) As with the present case, we reported in that study that bleeding points can be identified and reliable hemostasis can be achieved with UBT. Another advantage of this method is that intrauterine evacuation can be performed without technical restrictions and hemostasis can be achieved in a shorter time and at a lower cost relative to hysteroscopy or UAE.…”

Diagnosis and treatment of uterine artery pseudoaneurysm

“…Further, several case reports have mentioned the use of uterine balloon tamponade and laparoscopic surgery for the treatment of UAP. [ 11 , 12 ] Treatment options have therefore evolved from surgery to TAE, which is safe and effective in recent years especially for patients who desire fertility preservation. The surgical approach may be more suitable in cases of acute and massive bleeding when there is no time for TAE.…”

“…In the past, the main choice of treatment for UAP was open surgical management, including hysterectomy and ligation of uterine or internal iliac artery. Further, several case reports have mentioned the use of uterine balloon tamponade and laparoscopic surgery for the treatment of UAP [11,12] . Treatment options have therefore evolved from surgery to TAE, which is safe and effective in recent years especially for patients who desire fertility preservation.…”

Cervical Cerclage to Prevent Intrauterine Balloon Prolapse

“…However, invasive procedures have the potential to decrease fertility 4 ; therefore, measures to prevent balloon prolapse are important. 5,6 In 2011, Jain described the concept of the method of cerclage with IBT. 7 Here, we secondary describe a case of cervical cerclage with IBT for placenta previa that involved cervical dilation and we discuss the effect of IBT with cervical cerclage.…”