• Angiography
• Massive hemorrhage
• Postpartum hemorrhage
• Transarterial embolization
• Uterine artery pseudoaneurysm
• Uterine embolization
• Uterine vascular malformation
• Vascular anomaly

• Angiography
• Genital bleeding
• Gynecologic surgery
• Hemorrhagic complications
• Transvaginal ultrasonography
• Uterine artery embolization

• Embolization
• Pregnancy
• Spontaneous rupture
• Uterine artery (pseudo)aneurysm

• Female
• Humans
• Pregnancy
• Aneurysm, False/therapy
• Aneurysm, False/diagnostic imaging
• Pregnancy Complications, Cardiovascular/therapy
• Uterine Artery/diagnostic imaging
• Uterine Artery Embolization/methods

• Coil-embolization
• Pregnancy
• Uterine aneurysm

• Universitätsklinikum Düsseldorf. Anstalt öffentlichen Rechts (8911)

• embolization
• pregnancy
• uterine artery pseudoaneurysm

Uterine artery pseudoaneurysm (UAP) is a rare and potentially life-threatening vascular anomaly caused by inadequate sealing of a ruptured wall of a uterine artery. It mainly occurs after a traumatic lesion and can lead to delayed postpartum hemorrhage. We report a rare case of UAP after an uncomplicated vaginal delivery in a patient with a history of deep-infiltrating endometriosis. Selective coil embolization was successfully performed. UAPs should always be considered in cases of unexplained abdominal pain after surgery or childbirth with or without vaginal bleeding.

• embolization
• postpartum hemorrhage
• uterine artery pseudoaneurysm

• Cesarean scar pregnancy
• Pseudoaneurysm
• Ultrasound
• Uterine artery embolization
• Uterus

Pseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium. It is an uncommon condition that mainly occurs after traumatic injury to a vessel following pelvic surgical intervention, but also has been reported based on underlying endometriosis. There is an increased risk of developing UPA during pregnancy. Diagnosis includes clinical symptoms, with severe abdominal pain and is confirmed by sonographic or magnetic resonance imaging (MRI). Due to its potential risk of rupture, with a subsequent hypovolemic maternal shock and high fetal mortality, an interdisciplinary treatment should be considered expeditiously.

We present the case of a 34-year old pregnant symptomatic patient, where a large UPA was detected at 26 weeks, based on deep infiltrating endometriosis (DIE). The UPA was successfully treated by selective arterial embolization. After embolization, the pain decreased but the woman still required intravenous analgesics during follow-up. At 37 weeks she developed a sepsis from the intravenous catheter which led to a cesarean section and delivery of a healthy boy. She was discharged 10 days postpartum.

UPA should be considered in pregnant women with severe abdominal and pelvic pain, once other obstetrical factors have been excluded. DIE might be the underlying diagnosis. It is a rare but potentially life-threatening condition for mother and fetus.

• Deep infiltrating endometriosis
• Pregnancy
• Uterine pseudoaneurysm

Uterine artery pseudo-aneurysms (UAP) mainly occur after traumatic delivery or traumatic pregnancy termination. A UAP can be either asymptomatic or present with symptoms such as vaginal bleeding, abdominal pain, hypovolemic shock, or fever when infected. We describe a patient diagnosed with a uterine artery pseudo-aneurysm in pregnancy that required repeat embolization. The patient had no risk factors in her recent medical history. She did, however, undergo in-vitro fertilization with oocyte retrieval performed under transvaginal ultrasonographic guidance. We suggest the hypothesis of formation of the pseudo-aneurysm secondary to vascular injury during oocyte retrieval.

A 35-year-old primigravida, who conceived by in-vitro fertilization, presenting with severe abdominal pain at 19 2/7 weeks of gestation. Ultrasound examination with color doppler imaging revealed a hypo-echoic lesion with turbulent arterial flow pattern on the lower left side of the uterus. Selective catheterization and subtraction angiography permitted diagnosis of a large pseudo-aneurysm of the left uterine artery. A selective embolization was performed. Recanalization of the embolized artery was confirmed 11 weeks after initial presentation, requiring repeat embolization. A planned caesarean section was performed at 34 weeks of gestation and a healthy boy was born with a birth weight of 2065 g.

Uterine artery pseudo-aneurysm is a rare but potentially life-threatening condition. It can be diagnosed using (doppler) ultrasound, revealing a hypoechoic mass with swirling blood flow. Angiography is the standard reference in diagnosing UAP and may provide definitive treatment. Management with selective unilateral uterine artery embolization appears to be safe in hemodynamically stable patients. It does not compromise uteroplacental circulation and may help to prolong the pregnancy, reducing morbidity associated with preterm birth.

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Hypothesis of formation of pseudoaneurysm secondary to vascular injury during oocyte retrieval.

• Assisted reproductive technologies
• Case report
• IVF, in-vitro fertilization
• MRI, magnetic resonance imaging
• UAP, Uterine artery pseudo-aneurysm
• Uterine artery embolization
• Uterine artery pseudoaneurysm

• Aneurysm
• Anévrysme
• Artère utérine
• Embolisation
• Embolization
• Grossesse
• Pregnancy
• Uterine artery