Delayed postpartum hemoperitoneum due to uterine artery pseudoaneurysm rupture

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

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.

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

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.