Background. Evans syndrome (ES) is a chronic autoimmune disease characterized by autoimmune hemolytic anemia along with immune thrombocytopenic purpura. Few case reports of ES in pregnancy have been published, and ES may be difficult to distinguish from other diagnoses more common in pregnancy. Guidelines for treatment of ES are not well-defined. Case. A 23-year-old multigravid woman in active labor was found to have severe anemia and thrombocytopenia. She was diagnosed with ES and started on immunosuppressive treatments for persistent immune thrombocytopenic purpura. In the postpartum period, she was found to have coronavirus (COVID-19) infection and acute pulmonary embolism. Conclusion. Evans syndrome is a challenge to diagnose in pregnancy and poses important considerations for intrapartum and postpartum management.
INTRODUCTION:
There are limited data available regarding the rate of success and pregnancy outcomes for women after undergoing embolization for uterine artery arteriovenous malformation (AVM) which mostly comprise of case series and reports with small sample sizes. The purpose of this study is to evaluate fertility and pregnancy outcomes in patients who underwent interventional radiology-guided uterine artery embolization for uterine AVM at our institution.
METHODS:
IRB approval was obtained. A retrospective chart review was performed from 2008 to present looking at patients who had interventional radiology-guided uterine artery embolization. These patients' charts were reviewed for subsequent pregnancy incidence and outcome of those pregnancies.
RESULTS:
37 patients were diagnosed with uterine AVM. 18 chose to undergo UAE. Of those 18 patients, 7 attained subsequent pregnancies. Of the subsequent pregnancies, 4 patients had full-term deliveries and two of these four also had at least one miscarriage. One patient had only a miscarriage without any deliveries, and 1 had a voluntary termination of pregnancy with no other pregnancies documented for the duration of their follow up in our health system. No patients had preterm deliveries. No patients had post-procedure placental abnormalities in their subsequent pregnancies (no documented placenta previa, accreta, or percreta).
CONCLUSION:
Our data show that successful term pregnancies are possible after IR-guided treatment of uterine AVM. Future multi-institutional prospective studies are required to further prove or disprove results shown in this study. This data has the potential to impact counseling and management for patients who present with uterine artery AVM and desire future fertility.
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