{'fraction_non_alphanumeric': 0.023198594024604568, 'fraction_numerical': 0.01265377855887522, 'mean_word_length': 5.094218415417559, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Spontaneous rupture of utero-ovarian vessels in labour – A rare case of obstetric haemoperitoneum

Uterine artery embolisation (UAE) is a relatively new noninvasive treatment of symptomatic fibroids. Ravina et al. (1995) first used UAE in 1991 and published their first series on 16 patients in 1995. The reported range of shrinkage of the fibroids is 10 – 70%. However, there is a lack of long-term data on the efficacy of UAE, recurrence rate of fibroids and fertility after the procedure (National Institute for Clinical Excellence 2003). It is suggested that women should not conceive after the procedure until more is known about the long-term implications on the health of women themselves and development of their offspring (RCOG joint working party 2001). This is however too prescriptive. As will be expected from their background, many of these women would like to be pregnant and these pregnancies would be often strongly desired. Ravina et al. (2000) have not noticed any recurrence of fibroids during pregnancy or any abnormality in uterine vascularisation and contraction pattern, when monitored with monthly physical and sonographic examinations. Doppler studies of the feto-maternal vascularisation (uterine arteries, umbilical cord and fetal cerebral arteries) were also normal. They conclude that all these were indirect proof of safety and efficacy of UAE as a method of fibroid treatment in young women of childbearing age. However, a later analysis of 50 published cases of pregnancy after UAE shows that these pregnancies may be at risk of miscarriage, pre-term birth, malpresentation, caesarean delivery and postpartum haemorrhage (Goldberg et al. 2002). We feel this case is worth reporting, as the number of reported live births following fibroid embolisation is extremely small. In addition to the above potential risks to the baby during pregnancy, one needs to consider the long-term sequelae for the child, if any. In this patient there was no clinical evidence of utero-placental vascular compromise. There are many reported cases of myomectomy during caesarean section, but we have not found in the literature any case report of caesarean myomectomy after UAE. Although usually discouraged, many reports have suggested that it is safe to perform myomectomy during caesarean section if it is indicated, and correct surgical technique followed. Myomectomy in this case was not particularly difficult. We agree with the recommendation of the RCOG working party that there is a need of a national register of pregnancies following UAE. Such a register will help monitor the course of the pregnancy with possible complications, prepare guidelines for the optimum management of pregnancy and labour, devise patient information leaflets, and long term follow-up of the babies, especially childhood growth and development.