Brtnický Tomáš, Chmel Jr Roman, Nováčková Marta, Pavlík Radim, Chmel Roman
Department of Obstetrics and Gynecology, First Faculty of Medicine, University Hospital Bulovka, Charles University, Prague, Czech Republic -
Department of Obstetrics and Gynecology, Second Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic -
Minerva Obstet Gynecol. 2022 Apr;74(2):193-197. doi: 10.23736/S2724-606X.21.04834-X. Epub 2021 May 12.
Uterine artery pseudoaneurysm (UAP) is a rare complication during pregnancy that can cause serious consequences in both the pregnant woman and the fetus. Herein, we have described the cases of two pregnant women with UAP. Both patients had a history of laparoscopy for management of endometrioid ovarian cysts. Neither patient was operated in the retroperitoneum or around the uterine vessels. UAP was diagnosed by Doppler ultrasonography and confirmed by magnetic resonance imaging. Due to exacerbation of hypogastric pain, the first patient was treated shortly after admission to the hospital at the 23 week of gestation by endovascular intervention with occlusion of the UAP using microcoils. The patient's complaints resolved immediately, and a healthy baby was delivered via planned Cesarean section at the 38 gestational week. In the second case with twin pregnancy, angiography was performed at the 27 gestational week; however, the feeding vessel of the UAP could not be identified. The patient was followed up at weekly intervals, and due to increasing left hypogastric pain, cesarean section was performed at the 33 gestational week. During surgery, the left internal iliac artery was ligated and the entire pseudoaneurysm was successfully removed. Both women gave birth to healthy neonates; however, the therapeutic approaches were distinct in both cases. As the previous laparoscopic surgeries in both patients were performed only in the adnexal area, and not around the uterine arteries in the parametria, the endometrial decidual reaction could have caused the UAPs in the described cases.
子宫动脉假性动脉瘤（UAP）是妊娠期间一种罕见的并发症，可对孕妇和胎儿造成严重后果。在此，我们描述了两名患有UAP的孕妇病例。两名患者均有因子宫内膜样卵巢囊肿接受腹腔镜手术的病史。两名患者均未在腹膜后或子宫血管周围进行手术。UAP通过多普勒超声诊断，并经磁共振成像证实。由于下腹疼痛加剧，第一名患者在妊娠23周入院后不久接受了血管内介入治疗，使用微线圈闭塞UAP。患者的症状立即缓解，并在妊娠38周通过计划剖宫产分娩出一名健康婴儿。在第二例双胎妊娠病例中，在妊娠27周时进行了血管造影；然而，无法识别UAP的供血血管。对该患者每周进行随访，由于左下腹疼痛加剧，在妊娠33周时进行了剖宫产。手术期间，结扎了左髂内动脉，并成功切除了整个假性动脉瘤。两名女性均分娩出健康新生儿；然而，两例的治疗方法不同。由于两名患者之前仅在附件区域进行了腹腔镜手术，而未在子宫旁组织的子宫动脉周围进行手术，子宫内膜蜕膜反应可能导致了上述病例中的UAP。
