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Uterine Artery Embolization for Control of Life-threatening Uterine Bleeding
Çiğdem Nur Şahin 1, Beyzanur Can 1, Gül Şalcı 2, Hatice Sonay Yalçın Cömert 1, Mustafa İmamoğlu 1
1 Karadeniz Technical University Faculty of Medicine Department of Pediatric Surgery
2 Karadeniz Technical University, Faculty of Medicine, Department of Pediatric Surgery, Trabzon
Introduction: Abnormal uterine bleeding (AUB) is defined as amenstrual bleeding of unpredictable timing and variable amount. Acute AUB is a single episode of severe bleeding that requires immediate intervention to prevent further blood loss. Therapy for AUB should be initiated based on the suspected etiology and the acuity of the problem. Surgical management is rarely necessary. Uterine artery embolization is a method that can be used to prevent hysterectomy in patients who cannot achieve hemodynamic stability. We aim to analyze a case of heavy uterine bleeding in adolescence caused by an arteriovenous malformation (AVM).
Case: An 11-year-old girl is experiencing hypotensive attacks after her first vaginal bleeding. She had been bleeding for 6 pads/day for 11 days before her application. She has no known disease, bleeding disorder, trauma history, coitus history, and no oral contaceptive or medication use. Tachycardia was present during the patient's examination. Abdominal examination was normal except for diffuse minimal tenderness. There was active vaginal bleeding. Genital examination was normal. Despite 2 times of ES replacement, the patient's Hb value was 6.4 g/dl and USG and MRI examinations were performed. Hematometrocolpos was observed. Vaginoscopy was performed. It was seen that there was annular hymen and active bleeding from the cervical os. Angiography was performed considering bleeding from the uterus. Vascular malformation was detected in the bilateral uterine artery. The patient underwent bilateral embolization.
Conclusion: When a patient presents with acute uterine bleeding and demonstrates signs or symptoms of severe anemia or hemodynamic compromise uterin arter embolisation should be considered only as a life saving measure and a last resort to avoid hysterectomy. The long-term effects of this procedure on future fertility are not yet clear. Studies are required to determine the best embolic agents, effect on fertility, and outcome of pregnancies following this procedure.