Delayed hemorrhage as a result of ruptured uterine artery pseudoaneurysm after transmyometrial oocyte retrieval: Management by transcatheter arterial embolization using N-
butyl-2-cyanoacrylate

Background: Uterine artery Pseudoaneurysm is a rare cause of secondary postpartum hemorrhage (PPH) and can develop after various gynecological or obstetric procedures. The delayed diagnosis of such cases often results in life threatening situations. We report a rare case of bilateral uterine artery pseudoaneurysm that led to life threatening secondary PPH after Caesarean section in a patient who had several Caesarean sections before. Case description: A 35 years old multiparus women, who had all her four deliveries by Caesarean sections, presented with recurrent massive attacks of secondary PPH 35ays after her last delivery. Rupture of aneurysm of the uterine artery was suspected and CT angiography showed that the left uterine artery seemed more dilated and was probably the source of the PPH. The bleeding site was successfully tackled by selective arterial embolization. About three weeks later the patient presented again with severe recurrence of PPH. Repeat of CT angiography showed that the source was the right uterine artery this time, which was again selectively embolized. No further bleeding events occurred up to two years follow-up. Conclusion: Rupture of aneurysm of the uterine artery can be a life-threatening condition. Clinical suspicion is essential for a prompt diagnosis Definitive diagnosis can be achieved by CT-angiography. Treatment by selective embolization can effectively stop the bleeding.

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Μassive secondary postpartum hemorrhage caused by pseudoaneurysm of uterine artery, treated with uterine artery embolization – An uncommon case report

Hellenic Journal of Obstetrics and Gynecology ◽

10.33574/hjog.1987 ◽

2020 ◽

Vol 19 (2) ◽

pp. 95-100

Author(s):

Ioannis Kokolakis ◽

Fanis Makrigiannakis ◽

Afroditi Ziogou ◽

Antonios Makrigiannakis

Keyword(s):

Postpartum Hemorrhage ◽

Uterine Artery ◽

Arterial Embolization ◽

Treatment Method ◽

Angiographic Embolization ◽

Artery Ligation ◽

Artery Pseudoaneurysm ◽

Uncommon Case ◽

Secondary Postpartum Hemorrhage ◽

Uterine Artery Pseudoaneurysm

Introduction: Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage that can be fatal. Material & Methods: We present a case of a 42-year-old woman who developed massive secondary postpartum hemorrhage 17 days after c-section and was diagnosed to have pseudoaneurysm from the left uterine artery on computed tomography scan. After blood transfusion she got hemodynamically stable and selective transcatheter arterial embolization was performed. Results: The pseudoaneurysm was successfully obliterated. Conclusions: Angiographic embolization is a safe and competent method for managing postpartum hemorrhage caused by pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the preferred method for hemodynamically unstable patients when fertility preservation is strongly desired. In a woman with unexplained vaginal bleeding after c-section , pseudoaneurysm should be considered in the differential diagnosis of secondary postpartum hemorrhage. Angiographic embolization should be examined as a treatment method before turning to surgery, in suitable selected cases.

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Postpartum hemorrhage caused by uterine artery pseudoaneurysm: A case report

Case Reports in Women s Health ◽

10.1016/j.crwh.2021.e00286 ◽

2021 ◽

Vol 29 ◽

pp. e00286

Author(s):

Danielle Glassman ◽

Ruchi Karsalia ◽

Issam Moubarak ◽

Mark V. Sauer ◽

Ashima Singla

Keyword(s):

Case Report ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Overview of Neo-Vascular Lesions after Delivery or Miscarriage

Journal of Clinical Medicine ◽

10.3390/jcm10051084 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1084

Author(s):

Yuji Shiina

Keyword(s):

Arteriovenous Malformations ◽

Uterine Artery ◽

Spontaneous Regression ◽

Vascular Diseases ◽

Vascular Lesions ◽

Artery Pseudoaneurysm ◽

Retained Products Of Conception ◽

Products Of Conception ◽

Uterine Artery Pseudoaneurysm ◽

Retained Products

The concept of intrauterine neo-vascular lesions after pregnancy, initially called placental polyps, has changed gradually. Now, based on diagnostic imaging, such lesions are defined as retained products of conception (RPOC) with vascularization. The lesions appear after delivery or miscarriage, and they are accompanied by frequent abundant vascularization in the myometrium attached to the remnant. Many of these vascular lesions have been reported to resolve spontaneously within a few months. Acquired arteriovenous malformations (AVMs) must be considered in the differential diagnosis of RPOC with vascularization. AVMs are errors of morphogenesis. The lesions start to be constructed at the time of placenta formation. These lesions do not show spontaneous regression. Although these two lesions are recognized as neo-vascular lesions, neo-vascular lesions on imaging may represent conditions other than these two lesions (e.g., peritrophoblastic flow, uterine artery pseudoaneurysm, and villous-derived malignancies). Detecting vasculature at the placenta–myometrium interface and classifying vascular diseases according to hemodynamics in the remnant would facilitate the development of specific treatments.

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