Uterine Artery Pseudoaneurysm Manifesting as Delayed Postpartum Hemorrhage after Precipitous Delivery: Three Case Reports

Kim, Jong Woon; Kim, Yoon Ha; Kim, Chul Hong; Cho, Moon Kyoung; Kang, Woo Dae; Kim, Seok Mo; Yim, Nam Yeol; Song, Tae Bok

doi:10.1159/000363742

Cited by 7 publications

(7 citation statements)

References 10 publications

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“…8 The development of a pseudoaneurysm is due to an extraluminal blood collection that has a turbulent communication through an arterial wall defect. 1 The absence of a three-layered arterial wall lining in a pseudoaneurysm differentiates it from a true aneurysm. A UAP may be asymptomatic but usually presents with secondary postpartum hemorrhage (PPH) or delayed vaginal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…A pseudoaneurysm is defined as an extraluminal collection of blood with a turbulent flow that communicates with flowing arterial blood through a defect in the arterial wall. 1 Some authors have reported that a uterine artery pseudoaneurysm (UAP) occurs in 2–3/1,000 deliveries. 2 This condition has many causes, such as cesarean section, myomectomy, vaginal delivery, and hysterectomy.…”

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confidence: 99%

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Uterine Artery Pseudoaneurysm: A Case Report

Babiker

2020

Journal of Diagnostic Medical Sonography

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Pseudoaneurysm is an extraluminal collection of blood with a turbulent flow that communicates with flowing arterial blood through a defect in the arterial wall. Uterine artery pseudoaneurysm (UAP) is considered a rare case that occurs in 2–3/1,000 deliveries. A 33-year-old pregnant woman was admitted for a planned caesarian section. After a successful delivery, the patient experienced a postpartum vaginal bleeding 3 days later. Sonography revealed a suspected right UAP, and the diagnosis was confirmed by angiography. The defect was treated by uterine artery embolization.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Uterine Artery Pseudoaneurysm: A Case Report

Babiker

2020

Journal of Diagnostic Medical Sonography

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“…For example, when the uterine arteries and its branches ruptured, it mainly manifested with severe vaginal bleeding, [ 31 ] or vaginal bleeding accompanied by pelvic hematoma formation. [ 32 , 33 ] However, when the rupture site was located in the retroperitoneal space, including internal iliac arteries, CIA and the abdominal aorta, the mainly clinical characteristics were retroperitoneal hemorrhage or hematoma, abdomen pain, backache, and lumbago or even chest pain, associated with rapid heart rate, blood pressure changes, and even hemorrhagic shock caused by blood loss. If pseudoaneurysms rupture in the pelvic or abdominal arteries, bleeding will be more ferocious and harmful.…”

Section: Discussionmentioning

confidence: 99%

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Peng

Zhang

2018

Medicine

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Rationale:Placenta accreta is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy. Several hemostatic techniques have been performed in patients with placenta accreta to prevent PPH and reserve fertility. Abdominal aorta and pelvic arteries balloon occlusion are the only techniques which could be performed before cesarean section (CS) in patients who want to keep the fetus and reserve fertility. However, abdominal aorta and pelvic arteries balloon occlusion might lead to severe complications such as formation and rupture of pseudoaneurysm, angiorrhexis, etc.Patient concerns:We report a case diagnosed with pernicious placenta previa (PPP) combined with Rh(D) negative blood type, who was performed with bilateral common iliac arteries (CIA) balloon occlusion during CS. However, on the first day after CS, the patient caught sudden left-side lumbago and backache accompanied with palpitation and shortness of breath.Diagnoses:Formation and rupture of multiple pseudoaneurysms in left CIA.Interventions:Covered stent was inserted into the proximal part of the left CIA and the ipsilateral internal iliac artery was embolized by coil to prevent endoleak.Outcomes:The patient recovered and discharged from hospital in stable condition without other complications 9 days after CS.Lessons:It is of paramount importance that obstetricians and radiologists correctly estimate the appropriate occlusion volume and pressure of pelvic arteries before CS to avoid formation and rupture of a pseudoaneurysm. And if the rupture of a pseudoaneurysm occurred, it should be quickly identified and treated with endovascular intervention.

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“…The risk factors for uterine atony include prolonged labor, an overdistended uterus (e.g. with polyhydramnios, multiple gestation and macrosomia), Couvelaire uterus, high parity, chorioamnionitis, abruptio placentae, placenta previa, placenta accreta/increta/percreta and overuse of tocolytic agents or anesthetic agents [1,2,3,4,8,9,10,11,12]. Early diagnosis and management of risk factors may greatly decrease its incidence.…”

Section: Discussionmentioning

confidence: 99%

Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta

et al. 2015

Gynecol Obstet Invest

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Background/Aims: Postpartum hemorrhage (PPH) is a life-threatening condition with a worldwide occurrence. The purpose of this study is to evaluate the efficacy and safety of a reflexed compression suture in controlling severe atonic PPH with placenta accreta. Methods: Eleven women with severe PPH due to uterine inertia or placenta accreta were administered the reflexed compression suture. The procedure was to reflex the fundus onto the anterior wall of the uterus for compressing hemostasis and to form a ‘belt-like' binding suture to reinforce the effectiveness of pressing the myometrium. Results: Ten of the 11 women (90.9%) were successfully treated with the suture, and the uterus was preserved. None of these patients developed complications related to this method. Only in 1 patient with placenta increta could the bleeding not be stanched, and a peripartum hysterectomy was performed. Two women had pregnancies after the suture. Conclusion: The reflexed compression suture is a simple, swift, safe and effective technique of controlling uterine atonic bleeding, particularly in patients with an abnormally adherent placenta. The advantage of not having to conduct a hysterotomy also lies in reducing the duration of anesthesia and blood loss.

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Uterine Artery Pseudoaneurysm Manifesting as Delayed Postpartum Hemorrhage after Precipitous Delivery: Three Case Reports

Cited by 7 publications

References 10 publications

Uterine Artery Pseudoaneurysm: A Case Report

Uterine Artery Pseudoaneurysm: A Case Report

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta

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