Myometrial Defect in a Subsequent Pregnancy After Uterine Artery Embolization for Postpartum Hemorrhage, in the Absence of Leiomyomas or Previous Uterine Surgery

Abstract Background Pregnancy occurring after uterine artery embolization are often complicated by adverse fetal and obstetric outcomes. Case This report describes the case of a myometrial defect in a subsequent pregnancy after uterine artery embolization for postpartum hemorrhage. A 26-year-old gravida 2, para 2 woman had a vaginal delivery of twins 2 years earlier that required uterine artery embolization for postpartum hemorrhage. In this case, she presented at 18 3 weeks gestation with pelvic pain and an ultrasound scan revealing an area of myometrium measuring 3.2 mm. The myometrium progressively thinned to 0.7 mm at 32 weeks. After Caesarean hysterectomy, pathologic examination revealed large myometrial defects separate from the placenta increta. Conclusion Given the myometrial defects and placenta increta observed in a pregnancy after uterine artery embolization without documented fibroids or uterine surgery, consideration should be given to antenatal myometrial thickness surveillance.