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Open Access Case report

Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

Yun Mou1, Yuezhen Xu2, Ying Hu1 and Tianan Jiang1*

Author Affiliations

1 Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P. R. China

2 Department of Ultrasound, Zhejiang Xinan Hospital, Jiaxing, P.R. China

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BMC Women's Health 2014, 14:89  doi:10.1186/1472-6874-14-89

Published: 29 July 2014

Abstract

Background

Uterine artery pseudoaneurysms are dangerous and can lead to severe hemorrhage. We report an uncommon cause of a giant pseudoaneurysm in a missed miscarriage in a woman with a cesarean scar pregnancy.

Case presentation

The patient was a 25-year-old Chinese woman with a missed miscarriage in a cesarean scar pregnancy. Curettage was performed under ultrasound monitoring. A uterine artery pseudoaneurysm measuring 71 × 44 × 39 mm was detected the next day by Doppler ultrasonography. While waiting for admittance to an advanced institution to undergo embolization treatment, the pseudoaneurysm ruptured spontaneously. The subsequent severe hemorrhage necessitated hysterectomy.

Conclusion

A delay in diagnosis of uterine artery pseudoaneurysms may result from a long period between the curettage and follow-up examination. Ultrasound and Doppler ultrasonography should be performed repeatedly at short intervals to rule out them, especially in cesarean scar pregnancies. For a giant uterine artery pseudoaneurysm, interventional embolization might be the first treatment choice. If time allows, intra-operative ligation of the feeding vessels should be attempted before any decision to perform a hysterectomy is made. However, hysterectomy remains a possibility when severe bleeding occurs.

Keywords:
Uterus; Pseudoaneurysm; Ultrasound; Missed miscarriage; Cesarean scar pregnancy