title: Uterine artery pseudoaneurysm: its occurrence after non-traumatic events, and possibility of "without embolization" strategy.
abstract: OBJECTIVE
  Uterine artery pseudoaneurysm (UAP) has been considered to occur very rarely after traumatic delivery/abortion, and is usually detected after its rupture, yielding massive bleeding. Our hypothesis is: some UAP may be undetected without massive bleeding and may spontaneously resolve, and, thus, may not require transarterial embolization (TAE). We attempted: (1) to detect both ruptured and non-ruptured UAP, thereby characterizing candidates of spontaneously resolving UAP, and (2) to confirm that UAP is not rare and not always associated with traumatic events.
  
  
  METHODS
  This was a retrospective observational study of 50 women with angiographically confirmed UAP and treated by TAE. Angiograms and medical charts were retrieved to examine the associations among symptoms, ultrasound findings, and extravasation. Gray-scale ultrasound was performed for all women after delivery or abortion as our routine practice.
  
  
  RESULTS
  UAP occurred in 3-6/1000 deliveries and 40% occurred after non-traumatic deliveries/abortion. While 36% had active vaginal bleeding at admission, 64% did not. While 100% of patients with current active bleeding showed extravasation from the pseudoaneurysmal sac, patients without it showed a varied incidence of extravasation depending on the bleeding pattern/history and ultrasound findings. Interestingly, all patients with current bleeding (-), bleeding history (+), and ultrasound-discernable-intrauterine low echoic mass (-) were devoid of extravasation, suggesting that UAP may show progression to thrombosis and, thus, resolve spontaneously.
  
  
  CONCLUSIONS
  UAP may not be so rare and not associated with traumatic delivery/abortion. Some UAP may resolve, and, thus, may not require TAE, at least immediately.
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Yosuke
authors: Y
authors: Baba
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Hironori
authors: H
authors: Takahashi
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Akihide
authors: A
authors: Ohkuchi
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Hirotada
authors: H
authors: Suzuki
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Tomoyuki
authors: T
authors: Kuwata
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Rie
authors: R
authors: Usui
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Miyuki
authors: M
authors: Saruyama
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Manabu
authors: M
authors: Ogoyama
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Shiho
authors: S
authors: Nagayama
authors: Department of Radiology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Hiroyasu
authors: H
authors: Nakamura
authors: Department of Radiology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan.
authors: Atsushi
authors: A
authors: Ugajin
authors: Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Shimotsuke, Tochigi 329-0498, Japan. Electronic address: matsushi@jichi.ac.jp.
authors: Shigeki
authors: S
authors: Matsubara
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006801:Humans; D011247:Pregnancy; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D014463:Ultrasonography; D055988:Uterine Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D055357:Uterine Artery Embolization; D055815:Young Adult
keywords: Postabortal hemorrhage; Postpartum hemorrhage; Pseudoaneurysm; Transarterial embolization; Uterine artery pseudoaneurysm