Uterine Necrosis Following Uterine Artery Embolism Due To Postpartum Hemorrhage: A Case Report And Review

Uterine necrosis after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) is relatively rare. A 29-year-old primiparous woman had a diamniotic dichorionic twin pregnancy following frozen blastocyst transfer. She developed preeclampsia at 34+3 weeks, and cesarean section was performed due to lung edema at 35+2 weeks. UAE was performed using a gelatin sponge 3 hours after the operation due to PPH; however, the hemorrhage continued, and we performed a second UAE using n-butyl-2-cyanoacrylate. Uterine subinvolution continued after the second UAE, and her fever recurred 11 days after the operation. Magnetic resonance imaging suggested uterine necrosis 14 days after the operation, resulting in hysterectomy. The present study reviewed 17 cases of uterine necrosis following UAE in women with PPH, fever, abdominal/ pelvic pain and found that delayed appearance of various symptoms was common. A long-lasting subinvolution may be a novel specific feature of uterine necrosis in women with UAE due to PPH.