Embrittlement of uterus after uterine artery embolization: a case of uterine perforation

Abstract

Uterine artery embolization (UAE) is a common treatment for postpartum hemorrhage, however, the influences on uterus have yet to be uncertain. Here, we present a case of uterine embrittlement and perforation after UAE. A 30-year-old primipara received UAE for postpartum hemorrhage. Enhanced magnetic resonance imaging (MRI) after UAE showed lack of enhancement on uterine fundus. She complained hypomenorrhea after UAE, thus hysteroscopy was performed for intrauterine synechia. During the surgery, uterine perforation, which identical with the ischemic part on MRI, was found. It was repaired laparoscopically together with vulnerable surrounded area. With the case, because UAE tend to choose for woman who desire for the next pregnancy, we recommend that UAE should be limited and performed only for cases that could not accomplished hemostasis even with other methods. When UAE was chosen reluctantly, uterine myometrium ischemia should be monitored by contrast enhanced MRI.

Enclosing sutures technique for control of local bleeding in a case of placenta increta

“…Accordingly, partial removal and in situ management are at risk for requiring uterine artery embolization or hysterectomy. Although obvious with hysterectomy, uterine artery embolization also has a risk for uterine necrosis and uterine rupture during a subsequent pregnancy due to uterine ischemia . Thus, local hemostasis should be performed if possible.…”

“…Uterine artery embolization is relatively less invasive than hysterectomy for postpartum hemorrhage, and therefore is increasingly used. However, this still has a risk for severe complications, including uterine necrosis and uterine rupture during a subsequent pregnancy . Thus, several hemostatic techniques have been developed for use in cesarean section .…”

Hemostasis for Massive Hemorrhage during Cesarean Section

“…This technique is considered useful for patients in whom various local hemostatic procedures have failed to control hemorrhage [28,29]. However, the association of TAE with prolonged uterine ischemia has become apparent, even when an absorbable embolus such as Spongel® is used [33,34]. The following complications of TAE have been reported: Asherman syndrome; infertility; ovarian dysfunction (increase in follicle-stimulating hormone levels); endometrial hypoplasia; menstruation disorders (e.g., amenorrhea, menstrual irregularity, oligomenorrhea, and hypomenorrhea); and pregnancy wastage, puerperal massive hemorrhage, placenta accreta, placenta previa, and uterine rupture in subsequent pregnancies [3,4,28,29,33,34].…”

A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies

“…It was suggested that these remaining ischemic areas had induced uterine rupture in the subsequent pregnancy. 9,20) The decision to employ TAE should not be made without careful deliberation, particularly in patients who wish to have a subsequent pregnancy; TAE should be saved as the last option. The use of TAE to prevent massive hemorrhage prior to treatment for cervical pregnancy, cesarean section scar pregnancy, puerperal pseudoaneurysm, or placental polyp should be avoided whenever possible.…”