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Erschienen in: Journal of Medical Ultrasonics 2/2018

01.04.2018 | Case Report

Development of pseudoaneurysm in cesarean section scar pregnancy: a case report and literature review

verfasst von: Shunki Kiyokawa, Tatsuyuki Chiyoda, Kazunori Ueno, Keiko Saotome, Seon-Hye Kim, Sakura Nakada

Erschienen in: Journal of Medical Ultrasonics | Ausgabe 2/2018

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Abstract

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. It is becoming more common, but it can lead to uterine rupture and severe hemorrhage. Here, we report a case of a 37-year-old woman with CSP complicated with pseudoaneurysm. The pseudoaneurysm emerged following focal injection of methotrexate (MTX) and potassium chloride with systemic MTX treatment. Due to a risk of sudden bleeding, uterine artery embolization (UAE) was recommended, but the patient hoped to avoid this if possible. Because the serum human chorionic gonadotropin level and the gestational sac were still persistent, dilation and curettage were performed with interventional radiologists on standby. Severe hemorrhage occurred and continued during the procedure, which necessitated emergent UAE. We reviewed six CSP case reports with vascular abnormalities, and all of them necessitated UAE, surgical excision, or hysterectomy. In the case of CSP combined with pseudoaneurysm, treatment should be planned carefully considering the risk of massive hemorrhage.
Literatur
1.
Zurück zum Zitat Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends. 2011;5:139–50.CrossRefPubMed Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends. 2011;5:139–50.CrossRefPubMed
3.
Zurück zum Zitat Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, et al. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105:958–67.CrossRefPubMed Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, et al. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105:958–67.CrossRefPubMed
4.
Zurück zum Zitat Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373–81.CrossRefPubMed Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373–81.CrossRefPubMed
5.
Zurück zum Zitat Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23:247–53.CrossRefPubMed Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23:247–53.CrossRefPubMed
6.
Zurück zum Zitat Mou Y, Xu Y, Hu Y, et al. Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy. BMC Womens Health. 2014;14:89.CrossRefPubMedPubMedCentral Mou Y, Xu Y, Hu Y, et al. Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy. BMC Womens Health. 2014;14:89.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Timor-Tritsch IE, Monteagudo A, Santos R, et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1–13.CrossRef Timor-Tritsch IE, Monteagudo A, Santos R, et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1–13.CrossRef
8.
Zurück zum Zitat Chummun K, Kroon N, Flannelly G, et al. Severe postcoital bleeding from a uterine artery pseudoaneurysm 4 months after cesarean delivery. Obstet Gynecol. 2015;126:638–41.CrossRefPubMed Chummun K, Kroon N, Flannelly G, et al. Severe postcoital bleeding from a uterine artery pseudoaneurysm 4 months after cesarean delivery. Obstet Gynecol. 2015;126:638–41.CrossRefPubMed
9.
Zurück zum Zitat Chou MM, Hwang JI, Tseng JJ, et al. Cesarean scar pregnancy: quantitative assessment of uterine neovascularization with 3-dimensional color power Doppler imaging and successful treatment with uterine artery embolization. Am J Obstet Gynecol. 2004;190:866–8.CrossRefPubMed Chou MM, Hwang JI, Tseng JJ, et al. Cesarean scar pregnancy: quantitative assessment of uterine neovascularization with 3-dimensional color power Doppler imaging and successful treatment with uterine artery embolization. Am J Obstet Gynecol. 2004;190:866–8.CrossRefPubMed
10.
Zurück zum Zitat Cornette J, van der Wilk E, Janssen NM, et al. Uterine artery pseudoaneurysm requiring embolization during pregnancy. Obstet Gynecol. 2014;123:453–6.CrossRefPubMed Cornette J, van der Wilk E, Janssen NM, et al. Uterine artery pseudoaneurysm requiring embolization during pregnancy. Obstet Gynecol. 2014;123:453–6.CrossRefPubMed
11.
Zurück zum Zitat Kim D, Moon NR, Lee SR, et al. Acquired uterine arteriovenous malformation in a cesarean scar pregnancy. Taiwan J Obstet Gynecol. 2013;52:590–2.CrossRefPubMed Kim D, Moon NR, Lee SR, et al. Acquired uterine arteriovenous malformation in a cesarean scar pregnancy. Taiwan J Obstet Gynecol. 2013;52:590–2.CrossRefPubMed
12.
Zurück zum Zitat Rygh AB, Greve OJ, Fjetland L, et al. Arteriovenous malformation as a consequence of a scar pregnancy. Acta Obstet Gynecol Scand. 2009;88:853–5.CrossRefPubMed Rygh AB, Greve OJ, Fjetland L, et al. Arteriovenous malformation as a consequence of a scar pregnancy. Acta Obstet Gynecol Scand. 2009;88:853–5.CrossRefPubMed
13.
Zurück zum Zitat Akbayir O, Gedikbasi A, Akyol A, et al. Cesarean scar pregnancy: a rare cause of uterine arteriovenous malformation. J Clin Ultrasound. 2011;39:534–8.CrossRefPubMed Akbayir O, Gedikbasi A, Akyol A, et al. Cesarean scar pregnancy: a rare cause of uterine arteriovenous malformation. J Clin Ultrasound. 2011;39:534–8.CrossRefPubMed
14.
Zurück zum Zitat Kochhar PK, Sarangal M, Gupta U. Conservative management of cesarean scar pregnancy with uterine arteriovenous malformation: a case report. J Reprod Med. 2013;58:81–4.PubMed Kochhar PK, Sarangal M, Gupta U. Conservative management of cesarean scar pregnancy with uterine arteriovenous malformation: a case report. J Reprod Med. 2013;58:81–4.PubMed
15.
Zurück zum Zitat Sentilhes L, Gromez A, Clavier E, et al. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol. 2009;113:992–9.CrossRefPubMed Sentilhes L, Gromez A, Clavier E, et al. Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Obstet Gynecol. 2009;113:992–9.CrossRefPubMed
16.
Zurück zum Zitat Goldberg J, Pereira L, Berghella V. Pregnancy after uterine artery embolization. Obstet Gynecol. 2002;100:869–72.PubMed Goldberg J, Pereira L, Berghella V. Pregnancy after uterine artery embolization. Obstet Gynecol. 2002;100:869–72.PubMed
Metadaten
Titel
Development of pseudoaneurysm in cesarean section scar pregnancy: a case report and literature review
verfasst von
Shunki Kiyokawa
Tatsuyuki Chiyoda
Kazunori Ueno
Keiko Saotome
Seon-Hye Kim
Sakura Nakada
Publikationsdatum
01.04.2018
Verlag
Springer Japan
Erschienen in
Journal of Medical Ultrasonics / Ausgabe 2/2018
Print ISSN: 1346-4523
Elektronische ISSN: 1613-2254
DOI
https://doi.org/10.1007/s10396-017-0836-z

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