Pseudoaneurysm of uterine artery complicating caesarean section: a rare cause of intractable secondary postpartum haemorrhage managed with uterine artery embolisation

2021 ◽  
Vol 14 (3) ◽  
pp. e239851
Author(s):  
Aishvarya Gupta ◽  
Haritha Sagili ◽  
Nagarajan Krishnan ◽  
Papa Dasari
Keyword(s):  
Caesarean Section ◽  
Uterine Artery ◽  
Transvaginal Ultrasound ◽  
Uterine Artery Embolisation ◽  
Excessive Bleeding ◽  
Lower Segment Caesarean Section ◽  
Uterine Arteries ◽  
Ct Angiogram ◽  
Feeder Vessel ◽  
Arterial Feeder

A 27-year-old woman presented 6 weeks after an uncomplicated lower segment caesarean section with excessive bleeding per vagina. On examination, she had mild pallor with a pulse rate of 86 beats per minute and blood pressure of 116/80 mm Hg, uterus well involuted with closed cervical os and bleeding demonstrated through the cervix. A transvaginal ultrasonography with colour Doppler revealed a normal size uterus with an empty cavity and a hypoechoic area with blood flow within it in the left side of the uterus with a prominent arterial feeder vessel. A CT angiogram confirmed the diagnosis of a 1.3×0.7 cm pseudoaneurysm of the uterine artery near the left cornua of the uterus. After failed attempts to control the bleeding with antifibrinolytics, bilateral uterine arteries were embolised using gel foam. Post procedure, bleeding resolved immediately. A follow-up transvaginal ultrasound after a year revealed no evidence of the pseudoaneurysm and her fertility was preserved.

scholarly journals CAUSE DHEMORRAGIE POST PARTUM A LAQUELLE IL FAUT PENSER: PSEUDO-ANEVRISME DE LARTERE UTERINE APRES UNE CESARIENNE, A PROPOS DUN CAS

2021 ◽  
Vol 9 (4) ◽  
pp. 949-954
Author(s):  
Meimouna Mohamed Lemine Issehaghe ◽  
◽  
Khadija Bouras ◽  
Nessiba Abdelkadr Mohamed Zeine ◽  
Nisrine Mamouni ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Postpartum Hemorrhage ◽  
Uterine Artery ◽  
Post Partum ◽  
Arterial Embolization ◽  
Uterine Arteries ◽  
Determining Factor

Pseudoaneurysm of the uterine artery is a rare and poorly understood complication of Caesarean section or endocavitary manipulation. It can be responsible for severe postpartum hemorrhage, most often secondary or retarded. We present here a case of pseudoaneurysm of the left uterine artery diagnosed and treated in the gynecological-obstetrics department I, CHU HASSAN II DE FES. The diagnosis was guided by ultrasound but uterine arteriography of the uterine arteries remains a determining factor in establishing and making the diagnosis and also guiding the treatment.Selective arterial embolization was the treatment of choice. It has excluded the lesion, but vascular ligature or hysterectomy may be necessary if the patient is hemodynamically unstable.

scholarly journals Successful management of secondary postpartum haemorrhage due to post caesarean wound dehiscence with uterine artery embolisation

2021 ◽  
Vol 10 (6) ◽  
pp. 2534
Author(s):  
Pushplata Kumari ◽  
Anuja Abraham ◽  
Annie Regi ◽  
Preethi Navaneethan
Keyword(s):  
Uterine Artery Embolization ◽  
Vaginal Bleeding ◽  
Uterine Artery ◽  
Postpartum Haemorrhage ◽  
Wound Dehiscence ◽  
Abdominal Distension ◽  
Uterine Artery Embolisation ◽  
Artery Embolization ◽  
Lower Segment Caesarean Section ◽  
The Right

Caesarean scar dehiscence usually presents as secondary postpartum haemorrhage (PPH) with persistent spotting, fever or abdominal distension. The known management are either with laparotomy followed by resuturing of the scar or hysterectomy. However, most of the patient ultimately undergo hysterectomy due to the persistence of vaginal bleeding. We presented a case of PPH secondary due to scar dehiscence post lower segment caesarean section (LSCS), which was successfully managed with bilateral uterine artery embolization without hysterectomy. Our patient presented with vaginal bleeding on 16th post LSCS day and USG showed presence of a hyperechoic area measuring 5×6 cm more towards the right angle suggestive of the scar dehiscence with hematoma. She underwent bilateral uterine artery embolization and had decreased in the vaginal bleeding with gradual regression in the size of the hematoma over a period of time. Radiological intervention with bilateral uterine artery embolization (UAE) can be used as one of the modalities of management for the hemodynamically stable patient.

Structural changes in uterine tissues after uterine artery embolization in patients with leiomyoma complicated by uterine bleeding

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 78-82
Author(s):  
G P Titova ◽  
M M Damirov ◽  
L S Kokov ◽  
O N Oleynikova ◽  
G E Belozerov
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Structural Changes ◽  
Morphological Changes ◽  
Uterine Bleeding ◽  
Small Scale ◽  
Artery Embolization ◽  
Vessel Occlusion ◽  
Uterine Arteries ◽  
Uterine Tumors

Uterine leiomyoma (UL) is often complicated by the development of uterine bleeding. In urgent gynecology for the implementation of endovascular hemostasis, uterine artery embolization (UAE) is used. Performing UAE allows to stop and/or significantly reduce the intensity of bleeding and prepare a patient for surgical intervention. At the same time, the morphological changes that occur in uterine tissues in operated UL patients after performing the UAE are not studied. The aim was to study the peculiarities of pathomorphological changes in uterine tumors and tissues in operated UL patients complicated by uterine bleeding after performing UAE. Material and methods. The results of morphological changes appearing in tumors and tissues of the uterus in 39 operated UL patients, who were used for stopping uterine bleeding, were analyzed. Results. After applying different types of embolizing agents in macroscopic study of the uterus, signs of ischemia of its tissues were revealed, and the most pronounced disorders were detected in the UL nodes. Morphologically it was established that UAE microemboli resulted in vessel occlusion with increasing thrombosis in their distal sections. UAE was not accompanied by occlusal occlusion of the arteries and resulted in small-scale necrosis of the tumor with complete regeneration of the endometrium. Conclusions. The results of the morphological study showed that after the UAE was performed, the myomatous nodes underwent dystrophic, necrobiotic and necrotic changes. Depending on the nature of occlusion of the uterine arteries, various variants of necrosis (scale and completeness of the process) developed in the tumor tissue, which was aseptic in nature.

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