Super-selective arterial embolization for uncontrolled bleeding in abdominal pregnancy

BACKGROUND: Abdominal pregnancy with massive bleeding is life-threatening. Thus, multimodal treatment approaches are necessary. CASE: A 36-year-old woman with abdominal pregnancy at 14 weeks of gestation presented with abdominal pain due to intraabdominal bleeding. Laparotomy demonstrated massive bleeding from the placenta implanted in the right lower quadrant involving the posterior uterine wall, right adnexa, and small intestine. Because attempted removal of the placenta aggravated the bleeding, only the fetus was removed. To stop abdominal bleeding, embolization of the placental vasculature was successfully performed with a 2.0-F microcatheter after identification of the bleeding point with computed tomography arteriography. The patient was the treated with methotrexate. CONCLUSION: Super-selective arterial embolization with a microcatheter is a useful treatment of abdominal bleeding due to abdominal pregnancy.