Sonographic diagnosis of postpartum pseudoaneurysms of the uterine artery: A report of 2 cases

Abstract

Two cases of post-partum uterine artery pseudoaneurysm are described, 1 after normal vaginal delivery and the other after Caesarean section. Both cases were complicated by heavy bleeding and treated with catheter embolization. A turbulent arterial-type velocity waveform with high peak velocity and forward end-diastolic flow was registered in the feeding vessel. The peak blood flow velocity was high in both cases. The resistance index in the uterine artery was lower in the affected side of the uterus. Three-dimensional angiosonography was used to calculate the volume of the lesion, demonstrate its shape, and identify the feeding vessel.

Postpartum Ultrasound

“…40 Vascular abnormalities of the uterus have recently been described as possibly more common causes of severe SPH than previously thought. [25][26][27][28][29][30][31] In a Cochrane Review, Alexander et al 50 identified 45 papers about the management of SPH and concluded that little information is available from randomized trials to guide clinicians in the management of this condition. Since, the causes of SPH may be numerous, the best treatment options should be chosen according to the underlying cause of bleeding.…”

“…25,81 In contrast, acquired AV abnormalities of the uterus are associated with trauma after previous intrauterine procedures, RPT, infection or malignancy and are more common. [26][27][28][29][30][31] The difference between normal perivillous blood flow increased myometrial flow related to RPT and AV malformations seems to be difficult. 25,47,81 Three typical ultrasound signs of pseudoaneurysm include: A pulsating hypoechoic area connected to feeding artery by a narrow neck on Gray-scale ultrasound, a turbulent flow inside the pseudoaneurysm on color Doppler and a reversed flow on the neck of the pseudoaneurysm on pulse Doppler.…”

“…Several studies investigated antenatal ultrasound diagnosis of this condition 17-23 but a few papers have focused on postpartum ultrasound monitoring of retained placenta accreta. 24 Ultrasound can help to diagnose vascular lesions, congenital or acquired, [25][26][27][28][29][30][31] placental site tumor 32 and choriocarcinoma, which can also cause severe postpartum hemorrhage.…”

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).…”

Embolization of a left uterine artery mycotic aneurysm after a neglected, perforated appendicitis before delivery

“…As far as we know, this is the first case report in literature of a mycotic aneurysm of the proximal uterine artery that has been successfully embolized [3,[5][6][7].…”