Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

Abstract

BackgroundUterine artery pseudoaneurysms are dangerous and can lead to severe hemorrhage. We report an uncommon cause of a giant pseudoaneurysm in a missed miscarriage in a woman with a cesarean scar pregnancy.Case presentationThe patient was a 25-year-old Chinese woman with a missed miscarriage in a cesarean scar pregnancy. Curettage was performed under ultrasound monitoring. A uterine artery pseudoaneurysm measuring 71 × 44 × 39 mm was detected the next day by Doppler ultrasonography. While waiting for admittance to an advanced institution to undergo embolization treatment, the pseudoaneurysm ruptured spontaneously. The subsequent severe hemorrhage necessitated hysterectomy.ConclusionA delay in diagnosis of uterine artery pseudoaneurysms may result from a long period between the curettage and follow-up examination. Ultrasound and Doppler ultrasonography should be performed repeatedly at short intervals to rule out them, especially in cesarean scar pregnancies. For a giant uterine artery pseudoaneurysm, interventional embolization might be the first treatment choice. If time allows, intra-operative ligation of the feeding vessels should be attempted before any decision to perform a hysterectomy is made. However, hysterectomy remains a possibility when severe bleeding occurs.

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

“…Patients who were diagnosed with UAP, examined using CEU, and treated with UBT from January 2015 to December 2017 were eligible for inclusion. UAP was diagnosed according to the “to-and-fro pattern” 22 or “swirl pattern” 23 on color Doppler ultrasonography. Extravasation was diagnosed using computed tomography (CT) and double checked using CEU.…”

Severe Postcoital Bleeding From a Uterine Artery Pseudoaneurysm 4 Months After Cesarean Delivery

“…If embolization is not an option because of lack of expertise or time, intraoperative ligation of the pseudoaneurysm feeding vessels should be considered before resorting to hysterectomy, especially in patients with low parity. 9 …”

Intrauterine arterial pseudoaneurysm, a rare cause of per vaginal bleeding

“…The bleeding in both cases was intermittent and heavy which cannot be explained by pseudoaneurysmal rupture which will lead to severe life-threatening hemorrhage with subsequent vanishing of the aneurysm, but can be explained by rupture of the small arcuate or spiral arteries near the aneurysm or the small veins draining the pseudoaneurysm subsequent of high velocity and larger volumes of blood flow, they received from the pseudoaneurysm which acts like sac accumulating and then releasing blood from its lumen. Uterine pseudoaneurysm may cause elevation in β-hCG serum levels as it may contain residual decidual tissue or chorionic tissue in its walls [7].…”