Management of pregnancy and delivery in a patient with multiple gestation complicated by a true uterine artery aneurysm

Abstract

A true uterine artery aneurysm is a rare vascular pathology characterized by an abnormal outpouching of the vessel wall due to local wall thinning and loss of elasticity. The diagnosis of an unruptured true uterine artery aneurysm during pregnancy is challenging. The main risk of this condition lies in the potential for spontaneous rupture at any time, leading to massive intraperitoneal hemorrhage and, consequently, maternal and antenatal fetal death. Therefore, each case of aneurysm detection during pregnancy is considered unique. This article presents a clinical case of successful management of pregnancy and delivery in a patient with a dichorionic diamniotic twin pregnancy complicated by a true uterine artery aneurysm. The pathology was detected during the second trimester prenatal screening at 20–21 weeks of gestation. Delivery was performed at 32 weeks and 5 days of gestation by cesarean section due to preterm prelabor rupture of membranes of the first twin. The procedure and postoperative course were uneventful, and the patient was discharged on postoperative day 5. Birth weights and lengths were 1800/43 and 1450/42, respectively, with Apgar scores of 5/6/7 for both neonates. Subsequently, at 28 days of life, both infants were discharged in good condition and were scheduled for outpatient follow-up with a pediatrician, neurologist, and ophthalmologist at their local healthcare facility. The first twin weighed 2360 g and measured 46 cm, and the second twin weighed 2150 g and measured 44 cm. Key words: uterine artery aneurysm, malformation, hemorrhage, pregnancy, diagnosis, critical obstetric conditions, cesarean section