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Case Report
What to learn from a case of short-term pregnancy after uterine artery embolization for acquired uterine arteriovenous malformation
1 Obstetrics and Gynecology Unit, Maurizio Bufalini Hospital, Ausl Romagna, Cesena, Italy
2 Radiology Unit, Maurizio Bufalini Hospital, Ausl Romagna, Cesena, Italy
Address correspondence to:
Serena Solfrini
M.D., Obstetrics and Gynecology Unit, Maurizio Bufalini Hospital, Ausl Romagna, Viale G. Ghirotti 286, Cesena (FC) 47521,
Italy
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Article ID: 100105Z08SS2022
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Solfrini S, Rossi M, Tarsitano F, Giampalma E, Antonazzo P. What to learn from a case of short-term pregnancy after uterine artery embolization for acquired uterine arteriovenous malformation. J Case Rep Images Obstet Gynecol 2022;8: 100105Z08SS2022.ABSTRACT
Introduction: Acquired uterine arteriovenous malformations are rare causes of bleeding occurring after uterine curettage, gestational disease, abortion, or delivery. Uterine artery embolization is a safe and effective procedure to treat bleeding, although outcomes on fertility and subsequent pregnancy are yet to be defined.
Case Report: A 34-year-old nulliparous woman underwent medical treatment with misoprostol for first trimester miscarriage. After two weeks a transvaginal ultrasound found a round myometrial lesion with hypoechoic spaces, abundant vascularization suggestive of an acquired uterine arteriovenous malformation. A conservative management was adopted with ultrasound follow-up. Twenty days later a severe bleeding occurred and the patient was treated with bilateral uterine artery embolization. After three months the patient got pregnant and gave birth at term to a healthy and normal weight baby. Third stage of labor was complicated by placental retention requiring manual removal and postpartum hemorrhage managed with uterine hemostatic balloon positioning and blood transfusion.
Conclusion: In this case uterine artery embolization was followed by a very short-term pregnancy with vaginal birth and excellent neonatal outcome. Uterine ischemic changes could predispose to placental adhesion anomalies and contraction dysfunctions. An accurate ultrasound screening for placenta accreta spectrum disorders and an active management of third stage could be suggested.
Keywords: Arteriovenous malformation, Placenta accreta, Pregnancy, Uterine artery embolization
SUPPORTING INFORMATION
Author Contributions
Serena Solfrini - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Martina Rossi - Conception of the work, Design of the work, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Francesco Tarsitano - Conception of the work, Design of the work, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Emanuela Giampalma - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Patrizio Antonazzo - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Serena Solfrini et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
