Avoidable morbidity in a patient with pseudoaneurysm of the uterine artery after cesarean section

Abstract

We report the case of a 25-year-old female who presented to the emergency department with vaginal bleeding after a cesarean section. A diagnosis of pseudoaneurysm of the uterine artery was established radiologically; however, failure to consider this potentially life-threatening complication of cesarean section resulted in unnecessary morbidity. Doppler sonography and CT have been shown to be excellent tools for accurate diagnosis of uterine artery pseudoaneurysms, and selective arterial embolization remains the intervention of choice.

Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization

“…Rupture of a pseudoaneurysm of the uterine or vaginal artery as a cause of pelvic haemorrhage is not uncommon and is mainly due to uterine dilation and curettage [7] or occurs after pelvic surgery such as hysterectomy [8]. By comparison, postpartum haemorrhage related to a ruptured pseudoaneurysm is exceedingly rare [4,5,[9][10][11][12][13][14][15], and most published cases were single case reports [10,16] or included in the aggregate in larger series involving postpartum haemorrhage [4,17].…”

Delayed Postpartum Hemorrhage Resulting From Uterine Artery Pseudoaneurysm Rupture

“…The main primary causes are uterine atony (∼70% of cases), retained placental fragments, endometritis, genital laceration, uterine inversion or rupture, and coagulation disorders. Delayed postpartum hemorrhage, affecting 1∼3% of deliveries, occurs 24 h to 6 weeks postpartum and is usually due to endometritis, retained products of conception, or sloughing of the placental site eschar, and vascular abnormalities affecting the myometrial circulation (arterial aneurysm, pseudoaneurysm, and arteriovenous malformations) (4,5).…”

Pseudo aneurysm of uterine artery and cesarean scar dehiscence causing secondary post-partum haemorrhage managed by uterine artery embolisation: a case report

“…6,7 Rupture of pseudo aneurysm results in secondary PPH. Extension of uterine incision and additional haemostatic suture may be associated with occurrence of UAP after caesarean section.…”