Embolization of a rectus sheath hematoma in pregnancy

Fig. 1. A coronal T2-weightedmagnetic resonance image showing a large left-sided rectus sheath hematoma measuring 160×70×55 mm (arrow). Note the subcutaneous fat stranding and a small hemoperitoneum coexisting with a fetus of 33 weeks of gestation. 0020-7292/ $ – see front matter © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2008.08.021 muscle diseases, obesity, coughing, and vomiting [1,2]. Rectus sheath hematoma in pregnancy is a challenging condition owing to a number of alternate diagnoses, such as placental abruption, uterine rupture, and necrobiosis of leiomyoma; it has a reported maternal mortality rate of 11 % and a perinatal morbidity rate of 34 % [2]. Management includes conservative therapy if the patient and the hematoma are stable. In other conditions, surgical drainage and ligation of the vessel by laparotomy must be considered [1,2]. Successful outcomes with arterial embolization in nonpregnant women have been reported in the literature [3]. Embolization might allow a reduction of prematurity-associated morbidity and mortality by allowing rapid identification of the injured vessel, selective treatment, and delaying delivery. With regard to the safety of embolization during pregnancy, the general late onset of this pathology reduces the risks associated with fetal irradiation. In the present case, the large hema-toma displaced the uterus and fetus to the right, which reduced the dose of X-rays delivered to the fetus. Selective epigastric embolization in severe rectus sheath hematoma during the third trimester of pregnancy should be considered as the potential primary and alternative management path to classical laparotomy. Further studies are required to confirm that the maternal and fetal benefits outweigh the fetal risks associatedwith embolization