Preservation of uterine integrity via transarterial embolization under postoperative massive vaginal bleeding due to cesarean scar pregnancy.
OBJECTIVE
Cesarean scar pregnancy (CSP) is an uncommon type of ectopic pregnancy. It results in uterine rupture and severe hemorrhage during the proceeding gestation. Whether diagnosed early or not, it may cause maternal mortality or morbidity during emergency management. Life-saving emergency hysterectomy is usually the treatment of choice when there is profuse bleeding intraoperatively or after initial management.


METHODS
A 38-year-old woman with a history of two previous cesarean deliveries was referred to our clinic under the impression of CSP at 11 weeks' gestation. A viable embryo with a crown-rump length of 4.8 cm in the anterior wall of the uterus at the cervico-isthmic region was detected. Under the confirmation of CSP via ultrasonography, she was admitted for management. During hysterotomy, profuse bleeding with 1,000 mL blood loss was noted. After conservative procedure for hemostasis, however, massive vaginal bleeding persisted. As a result, we immediately transferred the patient to receive transarterial embolization (TAE) for bleeding control. The patient was discharged 4 days after the operation and TAE and her period resumed 1 month later.


CONCLUSIONS
Management of CSP is usually accompanied by profuse blood loss. Hysterectomy is inevitable if massive blood loss occurs during surgical intervention. For preservation of fertility and avoidance of mortality, our physicians offered an alternative life-saving policy even under catastrophic blood loss.
Chang
Chih-Yuan
CY
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Wu
Meng-Tzung
MT
Shih
Jin-Chung
JC
Lee
Chien-Nan
CN
D000328:Adult; D000792:Angiography; D002585:Cesarean Section; D002921:Cicatrix / Q000150:complications* / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D005260:Female; D005298:Fertility; D006801:Humans; D011184:Postoperative Period; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*