Preterm birth due to cervical insufficiency complicated by placenta accreta and postpartum haemorrhage managed by uterine artery embolisation

Elina Tetere, Anna Jekabsone, Ieva Kalere, Dace Matule


In this report, we present the case of a young woman undergoing her second pregnancy, with early detected shortened cervix resulting in cervical cerclage procedure. At gestational week 24/25, she presented at a hospital with signs of intra-amniotic infection and spontaneous rupture of membranes. This resulted in pathological preterm delivery with massive postpartum bleeding, which was managed by bilateral uterine artery embolization. Reasons for preterm birth and management options are discussed.


Preterm birth, Cervical cerclage, Placenta accreta, Uterine artery embolization

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Vyas NA, Vink JS, Ghidini A, Pezzullo JC, Korker V, Landy HJ, et al. Risk factors for cervical insufficiency after term delivery. Am J Obstet Gynaecol. 2006;195(3):787-91.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Obstetrical haemorrhage. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, eds. Williams Obstetrics. 23rd ed. New York, NY: The McGraw-Hill; 2010: 777-795.

Tunçalp Ö, Souza JP, Gülmezoglu M. New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet. 2013;123(3):254-6.

Huy NVQ. Cervical stitch (cerclage) for preventing pregnancy loss in women: RHL commentary (last revised: 1 September 2007). The WHO Reproductive Health Library; Geneva: WHO; 2007.

McElrath TF, Hecht JL, Damman O, Boggess K, Onderdonk A, Markenson G, et al. Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification. Am J Epidemiol. 2008;168(9):980-9.

Hassan S, Romero R, Hendler I, Gomez R, Khalek N, Espinoza J, et al. A sonographic short cervix as the only clinical manifestation of intra-amniotic infection. J Perinat Med. 2006;34(1):13-9.

Garmi G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accrete. Obstet Gynaecol Int. 2012;2012:7.

Mohan PP, Hamblin MH, Vogelzang RL. Uterine artery embolization and its effect on fertility. J Vasc Intervent Radiol. 2013;7:925-30.