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.