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

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.