Innovative procedure gives mother another chance of having children

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“I was in so much pain..."

When Katie Miller of Garnavillo, Iowa, was just over five weeks pregnant with her second child, she passed a blood clot and began experiencing pelvic pain.

“I was in so much pain one evening that I couldn’t even button or zip my pants,” recalls Katie. She called her local Emergency Room at Crossing Rivers Health in Prairie du Chien and was told to come right in.

Blood tests showed low pregnancy hormone levels (human chorionic gonadotropin or hCG) so her family doctor in Prairie du Chien monitored her closely over the next week.

“By Thursday, my hCG levels had dropped significantly, which can be a sign of miscarriage. I just hoped it wasn’t true,” says Katie.

“The news was much worse than we were expecting”

“The news was much worse than we were expecting,” says Katie. The Millers learned Katie’s pregnancy would not progress normally and the embryo was no longer living. Katie’s life was also in danger. She was told that she might require a hysterectomy when an ultrasound discovered something far more serious and rare—cesarean scar ectopic pregnancy.

Unlike most ectopic pregnancies, in which the embryo implants in a fallopian tube, the embryo implanted in Katie’s Cesarean section scar from her first pregnancy. Without treatment, the placenta would grow through the wall of Katie’s uterus, eventually rupturing and leading to a life-threatening hemorrhage.

Katie had never heard of cesarean scar ectopic pregnancy—few people have. It is considered the rarest type of ectopic pregnancy, occurring in about one in 2,000 pregnancies, though the incidence is increasing as cesarean deliveries become more common.

She was referred to obstetrician/gynecologist Mary Kuffel, MD, at Gundersen Health System in La Crosse that same day. Dr. Kuffel talked through Katie’s treatment options, one of which was uterine artery embolization. During this minimally invasive procedure, an interventional radiologist uses a catheter (via an artery in the groin) to deliver tiny particles that block the blood supply to the uterine body. Unlike a hysterectomy, the procedure would preserve Katie’s uterus and allow her and her husband, Nick, to potentially have children in the future.

"A new application of an existing technique"

“This is not so much a new procedure, rather a new application of an existing technique,” explains Gundersen interventional radiologist Ezana Azene, MD, who treated Katie. “We perform uterine artery embolization for symptomatic uterine fibroids. This is a similar procedure.”

An intravenous drug called methotrexate is commonly used to treat uterine ectopic pregnancies, according to Dr. Azene. If methotrexate doesn’t work, a hysterectomy or open surgery is often performed. Embolization is not as well-known, but is an excellent option for preserving fertility and minimizing recovery time.

“Nick and I feel so thankful that our paths crossed with Dr. Kuffel and Dr. Azene. Everything happens for a reason. I honestly think that if I would have gone somewhere else, I would have been without my uterus and unable to have another baby,” says Katie, who is pregnant again and expecting in February.