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Minerva Obstetrics and Gynecology 2021 May 12

DOI: 10.23736/S2724-606X.21.04834-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Uterine artery pseudoaneurysm in pregnant women with previous pelvic endometriosis

Tomáš BRTNICKÝ 1, 2 , Roman CHMEL Jr. 2, 3, Marta NOVÁČKOVÁ 2, Radim PAVLÍK 4, Roman CHMEL 2

1 Department of Obstetrics and Gynaecology, First Faculty of Medicine, University Hospital Bulovka, Charles University, Prague, Czech Republic; 2 Department of Obstetrics and Gynaecology, Second Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic; 3 Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; 4 Department of Radiology, Second Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic


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Uterine artery pseudoaneurysm (UAP) is a rare complication during pregnancy that can cause serious consequences in both the pregnant woman and the fetus. Herein, we have described the cases of two pregnant women with UAP. Both patients had a history of laparoscopy for management of endometrioid ovarian cysts. Neither patient was operated in the retroperitoneum or around the uterine vessels. UAP was diagnosed by Doppler ultrasonography and confirmed by magnetic resonance imaging. Due to exacerbation of hypogastric pain, the first patient was treated shortly after admission to the hospital at the 23rd week of gestation by endovascular intervention with occlusion of the UAP using microcoils. The patient’s complaints resolved immediately, and a healthy baby was delivered via planned Cesarean section at the 38th gestational week. In the second case with twin pregnancy, angiography was performed at the 27th gestational week; however, the feeding vessel of the UAP could not be identified. The patient was followed up at weekly intervals, and due to increasing left hypogastric pain, cesarean section was performed at the 33rd gestational week. During surgery, the left internal iliac artery was ligated and the entire pseudoaneurysm was successfully removed. Both women gave birth to healthy neonates; however, the therapeutic approaches were distinct in both cases. As the previous laparoscopic surgeries in both patients were performed only in the adnexal area, and not around the uterine arteries in the parametria, the endometrial decidual reaction could have caused the UAPs in the described cases.


KEY WORDS: Pseudoaneurysm; Uterine artery; Endometriosis; Pregnancy; Doppler ultrasound

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