TY - JOUR
T1 - Development of pseudoaneurysm in cesarean section scar pregnancy
T2 - a case report and literature review
AU - Kiyokawa, Shunki
AU - Chiyoda, Tatsuyuki
AU - Ueno, Kazunori
AU - Saotome, Keiko
AU - Kim, Seon Hye
AU - Nakada, Sakura
N1 - Funding Information:
The authors thank all members of the Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, for helpful discussions. The authors declare that there are no financial disclosures or conflicts of interest regarding this study.
Publisher Copyright:
© 2017, The Japan Society of Ultrasonics in Medicine.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. It is becoming more common, but it can lead to uterine rupture and severe hemorrhage. Here, we report a case of a 37-year-old woman with CSP complicated with pseudoaneurysm. The pseudoaneurysm emerged following focal injection of methotrexate (MTX) and potassium chloride with systemic MTX treatment. Due to a risk of sudden bleeding, uterine artery embolization (UAE) was recommended, but the patient hoped to avoid this if possible. Because the serum human chorionic gonadotropin level and the gestational sac were still persistent, dilation and curettage were performed with interventional radiologists on standby. Severe hemorrhage occurred and continued during the procedure, which necessitated emergent UAE. We reviewed six CSP case reports with vascular abnormalities, and all of them necessitated UAE, surgical excision, or hysterectomy. In the case of CSP combined with pseudoaneurysm, treatment should be planned carefully considering the risk of massive hemorrhage.
AB - Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. It is becoming more common, but it can lead to uterine rupture and severe hemorrhage. Here, we report a case of a 37-year-old woman with CSP complicated with pseudoaneurysm. The pseudoaneurysm emerged following focal injection of methotrexate (MTX) and potassium chloride with systemic MTX treatment. Due to a risk of sudden bleeding, uterine artery embolization (UAE) was recommended, but the patient hoped to avoid this if possible. Because the serum human chorionic gonadotropin level and the gestational sac were still persistent, dilation and curettage were performed with interventional radiologists on standby. Severe hemorrhage occurred and continued during the procedure, which necessitated emergent UAE. We reviewed six CSP case reports with vascular abnormalities, and all of them necessitated UAE, surgical excision, or hysterectomy. In the case of CSP combined with pseudoaneurysm, treatment should be planned carefully considering the risk of massive hemorrhage.
KW - Arterio-venous malformation
KW - Cesarean section
KW - Pregnancy
KW - Pseudoaneurysm
KW - Uterine artery embolization
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U2 - 10.1007/s10396-017-0836-z
DO - 10.1007/s10396-017-0836-z
M3 - Article
C2 - 29147816
AN - SCOPUS:85034217003
VL - 45
SP - 357
EP - 362
JO - Japanese Journal of Medical Ultrasonics
JF - Japanese Journal of Medical Ultrasonics
SN - 1346-4523
IS - 2
ER -