Uterine Artery Rupture After Induced Abortion and Extraction of an Intrauterine Device

An intrauterine device (IUD) is a safe, effective, simple, and reversible method for birth control, but some women with IUD may still become pregnant. Induced abortion is the main method for termination of pregnancy. If induced abortion is not well‑managed in these patients, it may result in serious vaginal bleeding and uterine rupture. We report a case of uterine artery rupture after induced abortion combined with extraction of an IUD. This case highlights the necessity of a standard operation for complicated induced abortion, and the value of interventional therapy, such as uterine artery embolization (UAE), for controlling serious vaginal bleeding. People's Hospital due to sudden vaginal bleeding for 1 h. At admission, she appeared pale and her consciousness was clear, with a blood pressure of 88/50 mmHg (1 mmHg = 0.133 kPa) and heart rate of 140 beats/min. In the vaginal assessment, there were a lot of blood clots in the vagina. After removal of these clots, we observed that the cervix and vagina had no lacerations, and the uterus was soft with a normal size. However, blood poured out from her cervix. No other remarkable findings were observed in a physical examination. The volume of blood loss was estimated to be 1500 ml in 1 h. Immediate intravenous access and fluid resuscitation were started with an initial diagnosis of hemorrhagic shock. An emergency urine pregnancy test was negative, and the hemoglobin concentration was 85 g/L. Detailed ultrasonography showed a 0.9‑cm heterogeneous echo band in the uterine cavity and a 1.3‑cm hypoechoic mass in the left lower uterine cavity with fluid flow echo inside. There was no free fluid in the pelvic cavity. Considering the heavily acute vaginal bleeding from the uterus, and a history of artificial abortion and extraction of IUD, we decided to perform emergent uterine artery embolism and treat shock simultaneously. During the surgery, extravasation of contrast media from the left uterine artery indicated rupture of this artery and revealed the active bleeding site in the uterine cavity [Figure 1]. The right uterine artery was normal [Figure 2]. The left uterine artery was embolized with a microcoil and gelatin sponge particles (350–560 μm) [Figure 3]. The right uterine artery was embolized only with gelatin sponge particles. A final angiogram confirmed successful occlusion of the target artery. Postoperatively, the patient recovered well and was discharged with no vaginal bleeding 6 days later. Forty‑two days later, her menses started …