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Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case series

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Uterine artery pseudoaneurysm (UAP) is rare but can cause life-threatening postpartum hemorrhage (PPH). To evaluate a novel sandwich embolization technique as a treatment for PPH caused by UAP.

Methods

This retrospective study included 10 patients with PPH caused by UAP who were treated using a modified sandwich embolization technique at the Radiology Department, Third Affiliated Hospital of Guangzhou Medical University between April 2009 and September 2018. Baseline clinical characteristics, intraoperative data (including treatment effectiveness) and postoperative data (including re-bleeding events and complications) were extracted from the medical records.

Results

Uterine arterial angiography showed cystic shadowing of the vascular wall during the arterial phase in all patients. Spraying of contrast agent into the pseudoaneurysm was observed for large UAPs, and the pseudoaneurysm disappeared in the venous phase. The pseudoaneurysm blood supply was from the uterine artery in 9 patients (90%) and the uterine, superior vesical, internal pudendal and nameless little arteries in 1 patient (10%). Bleeding symptoms were completely relieved in all patients after sandwich embolization. Eight patients experienced painful contractions in the perioperative period, but there were no other postoperative complications. During the 1-year postoperative follow-up, 9 patients (90%) had no re-bleeding symptoms/signs. One patient (10%), who had a pseudoaneurysm supplied by the uterine, superior vesical, internal pudendal and nameless little arteries, experienced re-bleeding 20 days after surgery and was treated by hysterectomy.

Conclusion

Modified sandwich embolization is an effective treatment for PPH caused by UAP.

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References

  1. Newsome J, Martin JG, Bercu Z, Shah J, Shekhani H, Peters G (2017) Postpartum Hemorrhage. Tech Vasc Interv Radiol 20(4):266–273. https://doi.org/10.1053/j.tvir.2017.10.007

    Article  PubMed  Google Scholar 

  2. Hoveyda F, MacKenzie IZ (2001) Secondary postpartum haemorrhage: incidence, morbidity and current management. BJOG 108(9):927–930. https://doi.org/10.1111/j.1471-0528.2001.00230.x

    Article  CAS  PubMed  Google Scholar 

  3. Neill A, Thornton S (2002) Secondary postpartum haemorrhage. J Obstet Gynaecol 22(2):119–122. https://doi.org/10.1080/01443610120113238

    Article  PubMed  Google Scholar 

  4. Yeniel AO, Ergenoglu AM, Akdemir A, Eminov E, Akercan F, Karadadas N (2013) Massive secondary postpartum hemorrhage with uterine artery pseudoaneurysm after cesarean section. Case Rep Obstet Gynecol 2013:285846. https://doi.org/10.1155/2013/285846

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zimon AE, Hwang JK, Principe DL, Bahado-Singh RO (1999) Pseudoaneurysm of the uterine artery. Obstet Gynecol 94(5 Pt 2):827–830. https://doi.org/10.1016/s0029-7844(99)00229-x

    Article  CAS  PubMed  Google Scholar 

  6. Bromley PJ, Clark T, Weir IH, Zwirewich CV (1997) Radiologic diagnosis and management of uterine artery pseudoaneurysm: case report. Can Assoc Radiol J 48(2):119–122

    CAS  PubMed  Google Scholar 

  7. Ciebiera M, Slabuszewska-Jozwiak A, Zareba K, Jakiel G (2017) Management of uterine artery pseudoaneurysm: advanced ultrasonography imaging and laparoscopic surgery as an alternative method to angio-computed tomography and transarterial embolization. Wideochir Inne Tech Maloinwazyjne 12(1):106–109. https://doi.org/10.5114/wiitm.2017.66503

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kwon JH, Kim GS (2002) Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization. Radiographics 22(1):35–46. https://doi.org/10.1148/radiographics.22.1.g02ja0735

    Article  PubMed  Google Scholar 

  9. Lee WK, Roche CJ, Duddalwar VA, Buckley AR, Morris DC (2001) Pseudoaneurysm of the uterine artery after abdominal hysterectomy: radiologic diagnosis and management. Am J Obstet Gynecol 185(5):1269–1272. https://doi.org/10.1067/mob.2001.117974

    Article  CAS  PubMed  Google Scholar 

  10. Dohan A, Soyer P, Subhani A, Hequet D, Fargeaudou Y, Morel O, Boudiaf M, Gayat E, Barranger E, Le Dref O, Sirol M (2013) Postpartum hemorrhage resulting from pelvic pseudoaneurysm: a retrospective analysis of 588 consecutive cases treated by arterial embolization. Cardiovasc Intervent Radiol 36(5):1247–1255. https://doi.org/10.1007/s00270-013-0668-1

    Article  PubMed  Google Scholar 

  11. Baba Y, Takahashi H, Ohkuchi A, Suzuki H, Kuwata T, Usui R, Saruyama M, Ogoyama M, Nagayama S, Nakamura H, Ugajin A, Matsubara S (2016) Uterine artery pseudoaneurysm: its occurrence after non-traumatic events, and possibility of "without embolization" strategy. Eur J Obstet Gynecol Reprod Biol 205:72–78. https://doi.org/10.1016/j.ejogrb.2016.08.005

    Article  PubMed  Google Scholar 

  12. Subramaniam S, Nadarajan C, Aziz ME (2018) Role of uterine artery embolization in pseudoaneurysm of uterine artery: a rare cause of secondary postpartum hemorrhage. Cureus 10(2):e2220. https://doi.org/10.7759/cureus.2220

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kuwata T, Matsubara S, Kaneko Y, Izumi A, Nakata M, Suzuki M (2010) Asymptomatic uterine artery pseudoaneurysm after cesarean section. J Obstet Gynaecol Res 36(2):405–410. https://doi.org/10.1111/j.1447-0756.2009.01134.x

    Article  PubMed  Google Scholar 

  14. Yi SW, Lee JH (2012) Uterine pseudoaneurysm leakage may cause delayed postpartum haemorrhage: multidetector CT with angiography and transcatheter uterine arterial embolisation. J Obstet Gynaecol 32(6):552–555. https://doi.org/10.3109/01443615.2012.694509

    Article  CAS  PubMed  Google Scholar 

  15. Yun SY, Lee DH, Cho KH, Lee HM, Choi YH (2012) Delayed postpartum hemorrhage resulting from uterine artery pseudoaneurysm rupture. J Emerg Med 42(1):e11–14. https://doi.org/10.1016/j.jemermed.2011.03.005

    Article  PubMed  Google Scholar 

  16. Baba Y, Matsubara S, Kuwata T, Ohkuchi A, Usui R, Saruyama M, Nakata M, Suzuki M (2014) Uterine artery pseudoaneurysm: not a rare condition occurring after non-traumatic delivery or non-traumatic abortion. Arch Gynecol Obstet 290(3):435–440. https://doi.org/10.1007/s00404-014-3226-4

    Article  PubMed  Google Scholar 

  17. Chummun K, Kroon N, Flannelly G, Brophy D (2015) Severe postcoital bleeding from a uterine artery pseudoaneurysm 4 months after cesarean delivery. Obstet Gynecol 126(3):638–641. https://doi.org/10.1097/AOG.0000000000000849

    Article  PubMed  Google Scholar 

  18. Asai S, Asada H, Furuya M, Ishimoto H, Tanaka M, Yoshimura Y (2009) Pseudoaneurysm of the uterine artery after laparoscopic myomectomy. Fertil Steril 91(3):929e1. https://doi.org/10.1016/j.fertnstert.2008.09.019

    Article  Google Scholar 

  19. Soyer P, Fargeaudou Y, Morel O, Boudiaf M, Le Dref O, Rymer R (2008) Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur Radiol 18(6):1181–1187. https://doi.org/10.1007/s00330-008-0876-2

    Article  PubMed  Google Scholar 

  20. Jain J, O'Leary S, Sarosi M (2014) Uterine artery pseudoaneurysm after uterine cervical conization. Obstet Gynecol 123(2):456–458. https://doi.org/10.1097/AOG.0000000000000093

    Article  PubMed  Google Scholar 

  21. Takeda A, Koyama K, Imoto S, Mori M, Sakai K, Nakamura H (2009) Early diagnosis and endovascular management of uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy. Fertil Steril 92(4):1487–1491. https://doi.org/10.1016/j.fertnstert.2008.08.019

    Article  PubMed  Google Scholar 

  22. Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, Boudiaf M, Sirol M, Ledref O (2015) Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. Cardiovasc Intervent Radiol 38(5):1068–1081. https://doi.org/10.1007/s00270-015-1054-y

    Article  PubMed  Google Scholar 

  23. Isono W, Tsutsumi R, Wada-Hiraike O, Fujimoto A, Osuga Y, Yano T, Taketani Y (2010) Uterine artery pseudoaneurysm after cesarean section: case report and literature review. J Minim Invasive Gynecol 17(6):687–691. https://doi.org/10.1016/j.jmig.2010.06.004

    Article  PubMed  Google Scholar 

  24. Matsubara S, Takahashi H, Arai-Saruyama M, Otachi H, Tada K (2017) Uneventful vaginal delivery after spontaneous resolution of uterine artery pseudoaneurysm. Acta Obstet Gynecol Scand 96(1):128–129. https://doi.org/10.1111/aogs.13016

    Article  PubMed  Google Scholar 

  25. Matsubara S, Takahashi Y, Kawai A (2014) Uterine artery pseudoaneurysm manifesting at the time of evacuation for abortion: pseudoaneurysm without preceding events. Acta Obstet Gynecol Scand 93(7):723–724. https://doi.org/10.1111/aogs.12361

    Article  PubMed  Google Scholar 

  26. Ito N, Natimatsu Y, Tsukada J, Sato A, Hasegawa I, Lin BL (2013) Two cases of postmyomectomy pseudoaneurysm treated by transarterial embolization. Cardiovasc Intervent Radiol 36(6):1681–1685. https://doi.org/10.1007/s00270-013-0551-0

    Article  PubMed  Google Scholar 

  27. Moatti Z, Nisner T, Saini A, Karoshi M (2011) Delayed postpartum haemorrhage secondary to a ruptured uterine artery pseudo-aneurysm, successfully treated by transarterial embolisation. BMJ Case Rep. https://doi.org/10.1136/bcr.05.2011.4270

    Article  PubMed  PubMed Central  Google Scholar 

  28. Nagayama S, Matsubara S, Horie K, Kuwata T, Ohkuchi A, Usui R, Nakata M, Suzuki M (2015) The ovarian artery: an unusual feeding artery of uterine artery pseudoaneurysm necessitating repetitive transarterial embolisation. J Obstet Gynaecol 35(6):656–657. https://doi.org/10.3109/01443615.2014.991295

    Article  CAS  PubMed  Google Scholar 

  29. Denison GL, Van Ha T, Keblinskas D (2005) Treatment of uterine artery vasospasm with transdermal nitroglycerin ointment during uterine artery embolization. Cardiovasc Intervent Radiol 28(5):670–672. https://doi.org/10.1007/s00270-004-0293-0

    Article  PubMed  Google Scholar 

  30. Cooper BC, Hocking-Brown M, Sorosky JI, Hansen WF (2004) Pseudoaneurysm of the uterine artery requiring bilateral uterine artery embolization. J Perinatol 24(9):560–562. https://doi.org/10.1038/sj.jp.7211119

    Article  PubMed  Google Scholar 

  31. Pelage JP, Le Dref O, Soyer P, Jacob D, Kardache M, Dahan H, Lassau JP, Rymer R (1999) Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus. AJR Am J Roentgenol 172(4):989–994. https://doi.org/10.2214/ajr.172.4.10587133

    Article  CAS  PubMed  Google Scholar 

  32. Razavi MK, Wolanske KA, Hwang GL, Sze DY, Kee ST, Dake MD (2002) Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology 224(3):707–712. https://doi.org/10.1148/radiol.2243011513

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the patients for participating in this study.

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Author notes

  1. Mimi Zhou and Tingwei Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Mimi Zhou, Tingwei Chen, Yongsen Li, Qianyan Tan, Huawei Shen, Duzhou Zheng, Shikuan Huang & Mingjin Cai

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  1. Mimi Zhou
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Contributions

Case collection: YL, QT; Postoperative follow-up: DZ, SH; Data processing: HS; Writing-original draft preparation: TC; Writing-review and editing and Article publication: MZ; Overall planning: MC.

Corresponding author

Correspondence to Mingjin Cai.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Third Affiliated Hospital of Guangzhou Medical University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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The requirement for informed consent was waived because the analysis was retrospective and anonymized.

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Zhou, M., Chen, T., Li, Y. et al. Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case series. Arch Gynecol Obstet 302, 1469–1477 (2020). https://doi.org/10.1007/s00404-020-05786-x

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