Two Cases of True Uterine Artery Aneurysms Diagnosed during Pregnancy

Abstract

We report 2 cases of true uterine artery aneurysms diagnosed during pregnancy. Both cases presented with nonspecific symptoms such as urethral obstruction, minimal vaginal bleeding and lower abdominal pain in the 2nd trimester. Both aneurysms were diagnosed by color Doppler ultrasound. In the first case labor was induced at 37 + 4 weeks of gestation. However, due to sudden fetal distress and maternal abdominal pain, an emergency Caesarean section was performed during labor, and 3 liters of intra-peritoneal blood were encountered upon laparotomy, secondary to a ruptured uterine artery aneurysm. In the second case, an elective Caesarean section was scheduled at 38 + 3 weeks of gestation, and the delivery and postpartum period were uncomplicated. Albeit a rare condition, a uterine artery aneurysm should be among the differential diagnosis considered in pregnant women who present with pelvic and vaginal masses, vague bladder symptoms or radiating pelvic pain. The diagnosis is readily made by color Doppler imaging. Elective Caesarean section should be the preferred mode of delivery to avoid rupture of the aneurysm during labor.

Uterine Artery Pseudoaneurysm: A Case Report

“…A UAP may be asymptomatic but usually presents with secondary postpartum hemorrhage (PPH) or delayed vaginal bleeding. 9 Some authors have indicated that UAP is a rare and potentially life-threatening lesion. 4 They described its mechanism as blood flowing into periarterial tissues after a wall defect.…”

“…A UAP may be asymptomatic but usually presents with secondary postpartum hemorrhage (PPH) or delayed vaginal bleeding. 9…”

“…Some authors have reported that a UAP usually presents with vaginal bleeding, and its diagnosis includes a gray-scale U/S and color Doppler. 9 They added that, on duplex color Doppler, pseudoaneurysms appear as a saccular arterial out pouch or an abnormal dilatation of an artery, with surrounding hematoma. Karmous et al 10 have suggested that pseudoaneurysm has a characteristic sonographic appearance consisting of a pulsating anechoic or hypoechoic well-defined cystic structure with or without associated pelvic hematoma or free fluid.…”

Juxtaisthmic uterine rupture caused by arterial aneurysm

“…Non-traumatic, spontaneous non-scarred uterine ruptures during childbirth are significantly less common than traumatic ones, and are associated with uterotonic stimulation or hyperstimulation, multiparity, protracted or precipitated childbirth, fetal malpresentation, and previous uterine instrumental procedures [1,2]. The most common site of rupture, locus minoris resistentiae, is the isthmic part of the uterus, which is the transition from the contraction to the distraction part of the uterus where the anatomical connection to the uterine vascular parametric plexus is located.…”

“…The most common site of rupture, locus minoris resistentiae, is the isthmic part of the uterus, which is the transition from the contraction to the distraction part of the uterus where the anatomical connection to the uterine vascular parametric plexus is located. A rupture there causes a rupture of the ascending or descending arm of the uterine artery with the development of massive intra-or retroperitoneal hemorrhage [1][2][3]. In addition to the listed possible causes, vascular anomalies, such as uterine artery or arteriovenous aneurysms, which change the vasculature and histoarchitectonics of the juxtaisthmic uterine part, are also mentioned as very rare causes.…”