A 38-Year-Old Woman With Sudden Dyspnea After Uterine Artery Embolization

A 38-year-old woman (gravida and para G4P3003) at 31 weeks' gestation with a history of placenta increta, hypothyroidism, and 3 prior cesarean deliveries sought treatment for vaginal bleeding. She reported occasional cramping and normal fetal movement, but did not report dizziness, chest pain, dyspnea, or urinary symptoms. She was found to have recurrent placenta increta, and after a multidisciplinary discussion, she was admitted for cesarean delivery with planned hysterectomy within 1 week of delivery. During the postpartum phase, her hemoglobin level continued to decline, despite blood transfusions. She subsequently underwent uterine artery embolization using Avitene or Embosphere, Gelfoam, glue, and coils before the hysterectomy. During the procedure, she demonstrated sinus tachycardia (120-130 beats/min) and required supplemental oxygen (4 L/min). The pulmonary team was consulted for worsening hypoxia.