Case report
A 30-year-old nulliparous patient was referred to our center, University Hospitals Leuven, for a suspicion of a molar pregnancy. The patient had an unremarkable medical and familial history. On initial ultrasound examination, an intrauterine pregnancy with crown-rump length (CRL) corresponding to a gestational age of 8 weeks 4 days was seen. The trophoblast appeared normal, but the myometrium was overall diffusely thickened due to venous plexuses that contained low flow rates(figure 1) . The presumptive diagnosis of a uterine hemangioma was confirmed on MRI at 10 weeks of gestation that demonstrated marked T2-hyperintens, T1-hypointens and non-diffusion restrictive enlargement of the entire myometrium enclosing multiple vessels (figure 2) .
The course of the pregnancy was rather uneventful, except for a minor bleeding episode at 13 weeks of pregnancy and a short admission at 28 weeks due to a single episode of nonspecific lower abdominal pain. The sonographic appearance of the myometrium remained unchanged during pregnancy (figure 3) . The patient was hospitalised from the 36th week of pregnancy onwards for observation to address the increased intra- and postpartum bleeding risk.
At 38 weeks and 5 days, labour was induced by means of prostaglandin E2 administration and subsequent artificial rupture of the membranes. This was followed by oxytocin labour augmentation and a spontaneous vaginal delivery of a healthy son weighing 2835 grams. Apgar scores were 9/10/10 and umbilical artery pH was 7.29. Intravenous carbetocin 100 µg and tranexamic acid 1 g were administered immediately, but within minutes a primary postpartum hemorrhage occurred with the placenta still in-utero. Sulprostone 500 µg perfusion was initiated, and a manual removal of the placenta was done. Additionally, a gentle curettage was performed to remove some retained membranes after which the uterus atony resolved, and the bleeding ceased. The total blood loss was estimated to be 1200 mL. Both the mother and newborn had an unremarkable postpartum course. Prophylactic postpartum low-molecular-weight heparin was continued for 6 weeks. After 3 months the myometrial hemangioma was markedly regressed on ultrasound. A whole-body MRI performed 8 months after delivery additionally noted a small 11 mm hemangioma in the liver segment 7.
Written consent was obtained from the patient whose case is presented above.