An unusual cause of fetomaternal distress at term: uterine vessel rupture in pregnancy

Calcott, Guy; Gaber, Mohamed A; Freedman, Jonathan; Patni, Shalini

doi:10.1136/bcr-2014-209004

Cited by 5 publications

(8 citation statements)

References 6 publications

(6 reference statements)

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“…The sparse literature on the subject makes it difficult to make recommendations in terms of the preferable delivery mode. However, based on our cases and the one by Calcott et al [7] , elective Caesarean section should be considered because of the risk of rupture of the aneurysm during labor, resulting in imminent risk of death for both the fetus and mother. …”

Section: Discussionmentioning

confidence: 97%

“…Our 2 cases of true UAA diagnosed during pregnancy highlight that although there is no common differential diagnosis for nonspecific pelvic and bladder symptoms, the condition can readily be diagnosed with color Doppler imaging in the antenatal period, thereby allowing for delivery by planned Caesarean sections and avoiding lifethreatening emergencies in labor to the mother and child [5][6][7] . UAA should be considered in the differential diagnosis in women with pelvic and vaginal masses, bladder symptoms, urethral obstruction or lower abdominal pain with radiation to the legs due to compression of nerve bundles.…”

Section: Discussionmentioning

confidence: 99%

“…UAA is a rare condition, and an exhaustive search was only able to identify 6 cases of true UAA in the English literature [2][3][4][5][6][7] . While 2 of these cases describe the diagnosis of an aneurysm in postmenopausal women [2,3] , the remaining 4 cases describe true UAA in relation to pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Two Cases of True Uterine Artery Aneurysms Diagnosed during Pregnancy

Schlütter

Johansen²,

Helmig³

et al. 2016

Gynecol Obstet Invest

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We report 2 cases of true uterine artery aneurysms diagnosed during pregnancy. Both cases presented with nonspecific symptoms such as urethral obstruction, minimal vaginal bleeding and lower abdominal pain in the 2nd trimester. Both aneurysms were diagnosed by color Doppler ultrasound. In the first case labor was induced at 37 + 4 weeks of gestation. However, due to sudden fetal distress and maternal abdominal pain, an emergency Caesarean section was performed during labor, and 3 liters of intra-peritoneal blood were encountered upon laparotomy, secondary to a ruptured uterine artery aneurysm. In the second case, an elective Caesarean section was scheduled at 38 + 3 weeks of gestation, and the delivery and postpartum period were uncomplicated. Albeit a rare condition, a uterine artery aneurysm should be among the differential diagnosis considered in pregnant women who present with pelvic and vaginal masses, vague bladder symptoms or radiating pelvic pain. The diagnosis is readily made by color Doppler imaging. Elective Caesarean section should be the preferred mode of delivery to avoid rupture of the aneurysm during labor.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Two Cases of True Uterine Artery Aneurysms Diagnosed during Pregnancy

Schlütter

Johansen²,

Helmig³

et al. 2016

Gynecol Obstet Invest

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“…It has the advantage of being minimally invasive, with fewer side effects and fewer postoperative complications than uterine artery ligation, internal iliac artery ligation or hysterectomy, which were previously used to control massive vaginal bleeding (12,13). In recent years this interventional technique has been widely used in the field of obstetrics and gynecology, especially in the treatment of postpartum hemorrhage (14), uterine fibroids (15) and cervical pregnancy (16), but there are still clinical concerns about whether UAE treatment of CSP will impair patients' reproductive function. In this trial, we treated CSP patients with UAE and analyzed its therapeutic effects as well as its impact on patients' serum Human chorionic gonadotropin (β-HCG) levels and fertility function.…”

Section: Introductionmentioning

confidence: 99%

Uterine Artery Embolization on Serum β-HCG Levels, Fertility Function and Clinical Efficacy in Patients With Cesarean Uterine Scar Pregnancy

Zhu

Zhang²,

Liu

et al. 2022

Front. Surg.

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ObjectiveTo analyze the therapeutic effect of uterine artery embolisation (UAE) in patients with cesarean section pregnancy (CSP) delivered by cesarean section and the effect on serum human chorionic gonadotrophin (β-HCG) levels and reproductive function.MethodsIn total 142 patients with CSP, The control group (n = 71) received Methotrexate (MTX) with ultrasound monitoring after admission and the research group (n = 71) was treated with UAE on basic of the control group. The two groups were compared in terms of treatment outcome, intraoperative bleeding, bed activity, vaginal bleeding and length of hospital stay, and serum follicle stimulating hormone (FSH), oestradiol (E2), luteinising hormone (LH) and β-HCG levels at 1 month postoperatively. The clinical symptoms (normalization of β-HCG and return of menstruation) and clinical outcomes (normal pregnancy, recurrent scar pregnancy) were compared between the two groups, as well as the occurrence of post-operative complications in both groups.ResultsCompared with the control group, the research group had a higher overall near-term effective rate, a lower recurrence rate of CSP in pregnancy, and a lower complication rate (P < 0.05); meanwhile, the time to get out of bed, postoperative vaginal bleeding, length of hospital stay, normalization of serum β-HCG, and return to menstruation were shorter in the research group than in the control group (P < 0.05); In addition, serum FSH, E2, LH and β-HCG levels improved better in the research group compared with the control group 1 month after surgery (P < 0.05).ConclusionThe treatment of CSP patients with UAE can reduce the amount of intraoperative bleeding and the duration of vaginal bleeding, promote the improvement of patients' clinical symptoms, have less impact on the disruption of patients' sex hormone balance, reduce patients' surgical risks to a greater extent, preserve patients' normal fertility, and have better application.

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“…However, nonspecific symptoms of artery rupture may result in unrecognizable severity and urgency of the problem, which can lead to death of both the mother and the child ( 14 ). The mortality of mothers with spontaneous rupture of uterus artery has dramatically decreased from 49% to 3.6% owing to improvement of intensive intraoperative and postoperative treatment ( 15 ). However, there is still a high percentage of perinatal mortality of 31% ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Rupture of Internal Iliac Artery in Pregnancy: Case Report

Butorac

Djaković

Košec

et al. 2018

ACC

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SUMMARY – Rupture of the internal iliac artery is a rare complication in pregnancy that is associated with maternal and fetal morbidity and mortality. We present a case of a 30-year-old primipara admitted to our department in 39 th week of gestation after sudden onset of intense abdominal pain. On admission, the patient was pale, tachycardiac, but with normal blood pressure and afebrile. Symptoms of acute abdomen were clear and surgery was indicated. Diagnosis was confirmed during cesarean section. Enlarged gravid uterus compressed the ruptured artery and prevented heavier bleeding. Acute bleeding due to arterial rupture causes severe symptoms, predominantly abdominal pain. Changes in blood count become significant some time after the onset of rupture. As the gravid uterus compressed the arterial rupture, preoperative bleeding was by far less abundant than the bleeding after the baby had been delivered and the size of the uterus decreased. Any cause of acute abdomen during pregnancy (abruption of the placenta, spleen rupture, visceral artery thrombosis) requires urgent surgical treatment, as well as intraoperative and postoperative intensive treatment. Rupture of the internal iliac artery is a rare complication in pregnancy, but has to be considered as a differential diagnosis of abdominal pain.

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An unusual cause of fetomaternal distress at term: uterine vessel rupture in pregnancy

Cited by 5 publications

References 6 publications

Two Cases of True Uterine Artery Aneurysms Diagnosed during Pregnancy

Two Cases of True Uterine Artery Aneurysms Diagnosed during Pregnancy

Uterine Artery Embolization on Serum β-HCG Levels, Fertility Function and Clinical Efficacy in Patients With Cesarean Uterine Scar Pregnancy

Spontaneous Rupture of Internal Iliac Artery in Pregnancy: Case Report

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