Elsarrag Sarah Z, Forss Abigail R, Richman Susan, Salih Sana M
Department of Obstetrics and Gynecology, Divisions of Reproductive Endocrinology and Infertility, University of Wisconsin, USA.
Department of Obstetrics and Gynecology, Yale University School of Medicine, USA ; County Obstetrics & Gynecology Group, New Haven, USA.
Clin Med Rev Case Rep. 2015 Jun;2(2). doi: 10.23937/2378-3656/1410040.
Uterine artery embolization for intractable postpartum hemorrhage saves lives while preserving fertility. The procedure-related risks of uterine infarction and ovarian insufficiency are rare. A primparous patient underwent bilateral internal hypogastric artery embolization to control severe postpartum hemorrhage following primary cesarean section. The bleeding continued, and a repeat aortogram demonstrated significant filling of the uterus from an anomalous proximal take off of the right uterine artery and from the left ovarian artery. Further embolization was required to control the bleeding. The patient developed acute primary ovarian insufficiency within two weeks of the procedure and subsequently presented with uterine infarction necessitating hysterectomy. This case demonstrates the increased risk of acute ovarian insufficiency and uterine infarction following uterine artery embolization for postpartum hemorrhage in the settings of aberrant pelvic vasculature.
子宫动脉栓塞术治疗难治性产后出血可挽救生命并保留生育能力。与该手术相关的子宫梗死和卵巢功能不全风险罕见。一名初产妇在初次剖宫产术后接受双侧髂内动脉栓塞术以控制严重产后出血。出血仍持续，重复主动脉造影显示子宫有大量造影剂充盈，原因是右侧子宫动脉近端异常起始以及左侧卵巢动脉供血。需要进一步栓塞以控制出血。患者在术后两周内出现急性原发性卵巢功能不全，随后出现子宫梗死，需要行子宫切除术。该病例表明，在盆腔血管异常的情况下，子宫动脉栓塞术治疗产后出血后发生急性卵巢功能不全和子宫梗死的风险增加。
