Transvaginal Ultrasound-Guided Thrombin Injection for Post-oocyte Retrieval Pseudoaneurysm in Pregnancy

TL;DR

A 42-year-old pregnant woman with a pseudoaneurysm was successfully treated with transvaginal ultrasound-guided thrombin injection, avoiding fetal radiation exposure.

Contribution

This case demonstrates the safe and effective use of TVS-guided thrombin injection for treating pseudoaneurysms during pregnancy.

Findings

TVS-guided thrombin injection led to immediate pseudoaneurysm thrombosis.

The patient experienced reduced pain and no further bleeding after the procedure.

Follow-up imaging confirmed persistent occlusion of the pseudoaneurysm.

Abstract

Transvaginal sonography (TVS)-guided oocyte retrieval is an assisted reproductive technology commonly performed for in vitro fertilization. This report presents the case of a 42-year-old primigravida, who presented in the second trimester of pregnancy with vaginal bleeding and left iliac fossa pain. Magnetic resonance imaging and TVS revealed a pseudoaneurysm in the left parametrium. To avoid radiation exposure to the fetus, TVS-guided embolization was planned for the patient. Under TVS guidance, a Chiba needle was advanced into the pseudoaneurysm sac, and lyophilized thrombin powder reconstituted in calcium chloride solution was injected. Immediate thrombosis of the pseudoaneurysm was observed. Her abdominal pain reduced after the procedure, and she did not have any further episodes of vaginal bleeding. Follow-up TVS performed after one month showed persistent occlusion of the pseudoaneurysm.

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