Shortened Cervix in the Subsequent Pregnancy after Embolization for Postpartum Cervical Hemorrhage

Introduction. Rupture of a branch of uterine artery during delivery often leads to a massive postpartum hemorrhage that can be successfully treated using uterine artery embolization. Case Report. A 33-year-old woman had a cesarean section at term followed by a secondary postpartum hemorrhage due to a ruptured cervicovaginal branch terminating in a large, partially thrombosed hematoma of the cervix. She was given selective uterine artery embolization, and she was discharged to home in stable condition on the third day after embolization. In the forthcoming pregnancy a shortened cervix was a risk of threatened premature delivery from 26 weeks of gestation onwards. Conclusion. Superselective unilateral embolization of a thrombosed hematoma in the cervix might prevent extensive iatrogenic trauma of the cervix, which allows preservation of reproductive function. 1. Introduction The rupture of a branch of uterine artery subsequent to a delivery is a rare cause of postpartum hemorrhage that can be often successfully treated by uterine artery embolization (UAE). To our knowledge, no obstetrical followup in the subsequent pregnancy after UAE has been published so far. 2. Materials and Methods A 33-year-old healthy, nonsmoking, normal-weight, primiparous, Caucasian woman had an uncomplicated pregnancy. During spontaneous labor at full term, the cervix was completely dilated after 6 hours, and a relative cephalopelvic disproportion was suspected based on the lack of descent of the fetal head without any clinical sign of chorioamnionitis. A cesarean section was performed via low isthmic incision. Her immediate postpartum course was unremarkable with no pathological bleeding. Fifteen days later she was readmitted with persistent uterine bleeding. The cervix was tender by palpation and enlarged with widened external orifice. Doppler ultrasound (US) examination showed an extraluminal collection of blood with turbulent echo within the cervix. Computed tomography (CT) angiography presented a partially thrombosed large hematoma within the wall of cervix (Figure 1). Digital subtraction angiography was carried out on an emergency basis using right-sided transfemoral intervention. Contralateral internal iliac artery angiography revealed contrast media extravasation from a ruptured left cervical arteriolar branch of the uterine artery (UA). CT showed a ruptured branch terminating in a large, partially thrombosed hematoma (6.2？cm × 5？cm × 6？cm) embedded in the left part of the cervix. The thrombus was encircled with the thin wall of the cervix, whereas inside the thrombus, a