Obstet Gynecol Sci.  2024 May;67(3):335-338. 10.5468/ogs.23287.

Prognosis of subsequent pregnancy in uterine necrosis after uterine artery embolization

• Lee KE
• Lee SU
• Kang J
• Lim HW
• Park IY
• Kim MJ

• KMID: 2555517
• DOI: http://doi.org/10.5468/ogs.23287

Abstract

In an 8-year period at two medical center, 138 patients underwent uterine artery embolization, and 11 of them were diagnosed with uterine necrosis. Among them, three were successfully conceived. However, one of them developed an arteriovenous malformation after an artificial abortion, and another experienced complications, including placenta previa and placenta accreta spectrum, which resulted in early preterm delivery and recurrent postpartum hemorrhage, necessitating subtotal hysterectomy. Therefore, it is crucial to prepare for potential adverse pregnancy outcomes in subsequent pregnancies for patients with a history of uterine necrosis.

Keyword

Uterine disease; Placenta accreta; Pregnancy complications; Uterine artery embolization

Figure

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  Fig. 1 Abdomen pelvis CT and transvaginal sonography in case 1. (A) Axial plane and (B) coronal plane of CT before UAE. The leakage of the contrast medium and hematoma are visible (white arrow). (C) After dilatation and curettage at 8 weeks gestation, the patient was referred again for amenorrhea. We performed enhanced abdomen-pelvis CT and AVM was diagnosed. (D) Sagittal plane of transvaginal sonography. Dilated vessels is observed. (E) When color Doppler was applied, massive blood flow in uterine body and fundus is observed. CT, computed tomography; UAE, uterine artery embolization; AVM, arteriovenous malformation.

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  Fig. 2 Enhanced abdomen-pelvis CT at the time of uterine necrosis and non-enhanced uterus MRI at 17 weeks gestation age of case 2. (A) Axial plane of enhanced abdomen-pelvis CT. Partial uterine necrosis in the anterior and fundal wall are identified. Free air is observed in the intrauterine cavity. (B) The axial plane of non-enhanced uterus MRI. Placenta previa (white arrow) is identified. PAS was not observed, but the portion of placenta increta and percreta at the time during cesarean section on gross was indentified. CT, computed tomography; MRI, magnetic resonance imaging; PAS, placenta accreta spectrum.

Reference

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