Pseudo aneurysm of the uterine artery with arteriovenous fistula after cesarean section: A rare but sinister cause of delayed postpartum hemorrhage

Abstract

Pseudoaneurysm of the uterine artery is a rare complication of cesarean section. Delayed diagnosis and management may result in rapid and catastrophic postpartum hemorrhage and may necessitate hysterectomy or can even be fatal. A 28‐year‐old woman (gravida I, para I) presented with delayed postpartum hemorrhage 10 days after emergency cesarean section. Using transabdominal and transvaginal Color Doppler sonography, we detected a pseudoaneurysm in the posterior uterine wall, which was successfully treated with selective embolization distal and proximal to the lesion with platinum coils. In patients with delayed postpartum hemorrhage—especially after cesarean section—the rare possibility of uterine artery pseudoaneurysm must be kept in mind.

Uterine Artery Pseudoaneurysm After Cesarean Section: A Rare Cause of Delayed Postpartum Hemorrhage

“…Therefore, early recognition of uterine artery pseudoaneurysm is critical for patient management due to its high risk of rupture. Moreover, in every case of delayed postpartum hemorrhage, a high index of suspicion regarding the formation of uterine artery pseudoaneurysm is warranted, especially because delayed diagnosis can lead to incorrect management and poor outcomes [11]. Uterine artery pseudoaneurysm can usually be diagnosed using color Doppler ultrasonography [12].…”

Uterine Artery Pseudoaneurysm after an Uncomplicated Vaginal Delivery: A Case Report

“…UAPs mainly occur after traumatic delivery including caesarean section [ 6 , 7 ] or other surgical procedures such as hysterectomy, myomectomy, curettage or conization [ 8 , 9 , 10 ]. However, UAPs may occur after uncomplicated vaginal deliveries and during pregnancy [ 11 ].…”

The role of ultrasound in the diagnosis and management of postpartum hemorrhage

“…The diagnosis of uterine inversion is usually done clinically one but some authors described typical ultrasonographic signs that may help in performing the diagnosis: on sagittal view the collapsed fundus appear as a mass at increased echogenicity when compared to the surrounding hypoechoic uterine walls (target sign). 28 31 The typical clinical symptoms are intermittent, excessive vaginal bleeding for postpartum and pelvic pain. 32 nent is situated in the endometrium, the vascular component in AVM is primarily located inside the myometrium.…”

“…Uterine arteriovenous malformations (UAVM) are infrequent vascular anomalies characterized by an atypical arteriovenous communication between the branches of myometrial arteries and the uterine venous plexus. UAVM mostly occur after postsurgery uterine trauma and can induce massive PPH leading to potentially life‐threatening anemic shock 31 . The typical clinical symptoms are intermittent, excessive vaginal bleeding for postpartum and pelvic pain 32 .…”