Sheryl Choo1, Daniele Wiseman2, J Barry MacMillan3, Robert Gratton4. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON. Electronic address: sherylchoomail@gmail.com. 2. Division of Interventional Radiology, Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON. 3. Division of Urogynaecology, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON. 4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON.
Abstract
BACKGROUND: Pregnancy occurring after uterine artery embolization are often complicated by adverse fetal and obstetric outcomes. CASE: This report describes the case of a myometrial defect in a subsequent pregnancy after uterine artery embolization for postpartum hemorrhage. A 26-year-old G2, P2 woman had a vaginal delivery of twins 2 years earlier that required uterine artery embolization for postpartum hemorrhage. In this case, she presented at 183 weeks gestation with pelvic pain and an ultrasound scan revealing an area of myometrium measuring 3.2 mm. The myometrium progressively thinned to 0.7 mm at 32 weeks. After cesarean hysterectomy, pathologic examination revealed large myometrial defects separate from the placenta increta. CONCLUSION: Given the myometrial defects and placenta increta observed in a pregnancy after uterine artery embolization without documented fibroids or uterine surgery, consideration should be given to antenatal myometrial thickness surveillance.
BACKGROUND: Pregnancy occurring after uterine artery embolization are often complicated by adverse fetal and obstetric outcomes. CASE: This report describes the case of a myometrial defect in a subsequent pregnancy after uterine artery embolization for postpartum hemorrhage. A 26-year-old G2, P2 woman had a vaginal delivery of twins 2 years earlier that required uterine artery embolization for postpartum hemorrhage. In this case, she presented at 183 weeks gestation with pelvic pain and an ultrasound scan revealing an area of myometrium measuring 3.2 mm. The myometrium progressively thinned to 0.7 mm at 32 weeks. After cesarean hysterectomy, pathologic examination revealed large myometrial defects separate from the placenta increta. CONCLUSION: Given the myometrial defects and placenta increta observed in a pregnancy after uterine artery embolization without documented fibroids or uterine surgery, consideration should be given to antenatal myometrial thickness surveillance.