Angiography as treatment for a high cervical tear. A case report.
BACKGROUND
High cervical tears are a rare but serious complication of second-trimester induced abortion. Angiographic embolization can successfully treat selected cases. This is the first case of serious hemorrhage successfully treated by angiography alone, without mechanical occlusion, after failed surgical repair.


METHODS
A 22-year-old primigravida sustained a high cervical tear during dilation and evacuation (D&E) abortion at 21 weeks' gestation. After stabilization with 4 units of packed red cells and vaginal packing, attempted surgical repair failed. The following day, angiography alone pinpointed and stanched the small arteriolar branch of the uterine artery responsible for the bleeding.


CONCLUSIONS
Injury to a tiny arteriolar branch of the uterine artery during D&E abortion may be impossible to palpate or visualize, and hemostatic sutures placed extrinsically on the cervical mucosa may not be therapeutic. On occasion, injection of contrast material, without mechanical occlusive devices, may be corrective.
Department of Obstetrics and Gynecology, Northwestern University Medical Center, Albany Medical-Surgical Center, Chicago, Illinois, USA. fpamg@cais.com
E Steve
ES
Lichtenberg
D000032:Abortion, Therapeutic / Q000009:adverse effects* / Q000379:methods; D000328:Adult; D000792:Angiography / Q000379:methods; D002584:Cervix Uteri / Q000293:injuries*; D004107:Dilatation and Curettage / Q000009:adverse effects* / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*