A ruptured vulvar labial artery pseudoaneurysm causes a secondary postpartum hemorrhage: A case report

Leaf, Marie-Claire; Schmidt, Luke; Serna-Gallegos, Tasha; Lane, Felicia

doi:10.1016/j.crwh.2020.e00184

Cited by 5 publications

(8 citation statements)

References 7 publications

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“…Most post-partum pseudoaneurysms have been described in the uterine artery, and it is quite rare at other locations such as the vagina. Few cases of vaginal pseudoaneurysm managed by selective artery embolization have been reported involving different arteries such as the vaginal artery, left internal pudendal artery, left obturator artery, and the labial artery ( 2 , 3 , 10 ) . The definitive diagnosis of pseudoaneurysm is made by angiography; however, both USG Doppler or contrast CT can be useful for its detection, as in our second case, and in monitoring the size of an unruptured pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and intervention in the form of embolization help in decreasing patient morbidity. There is a lack of data in the literature regarding the investigation of choice, at present, however, CT angiography is the investigation of choice to delineate detailed anatomy of pelvic vasculature and to identify any leaking point if present, in cases of episiotomy site hemorrhage ( 4 , 10 ) .…”

Section: Discussionmentioning

confidence: 99%

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Endovascular management of episiotomy site hematoma: Two cases and a brief review

Shivhare¹,

Meena²,

Kumar³

et al. 2021

tjod

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Episiotomy site hematoma, though uncommon, can be associated with serious maternal morbidity. It arises mostly due to tissue trauma or injury to blood vessels, leading to the formation of a pseudoaneurysm. Sometimes, when surgical management fails, embolization of the bleeding vessel is a lifesaving option. Here, we report two cases of episiotomy site hematoma that required selective arterial embolization for management, following the failure of surgical management. A 28-year-old G6A5 woman underwent forceps delivery following which she developed a 6*6-cm right-sided vulvovaginal hematoma at the episiotomy site. After failed surgical management, arterial embolization was performed and hemostasis was achieved. A 26-year-old P2L2 woman with a history of surgical exploration for episiotomy site hematoma, presented postdelivery on postpartum day seven with profuse vaginal bleeding. Her computed tomography angiogram revealed a pseudoaneurysm of around 2.1*1 cm in length with a vaginal hematoma of 4*5 cm. Selective artery embolization performed and complete hemostasis was achieved with no complications. Selective arterial embolization is a safe therapeutic option for episiotomy site hematoma, especially if surgical management fails.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular management of episiotomy site hematoma: Two cases and a brief review

Shivhare¹,

Meena²,

Kumar³

et al. 2021

tjod

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“…Most vulvovaginal hematomas are small and resolve with conservative measures alone, although few require surgical intervention. Pelvic artery pseudoaneurysm, another unique obstetrical complication, typically arises from the uterine artery and presents as secondary postpartum hemorrhage due to heavy uterine bleeding [8,11]. Rarely does a pseudoaneurysm of the pelvic vasculature cause a rapidly expanding vulvovaginal hematoma in the immediate postpartum period.…”

Section: Discussionmentioning

confidence: 99%

“…It is our understanding that there are only three other reports describing a postpartum pelvic artery pseudoaneurysm arising from a source that is not the uterine artery [9][10][11]. These included pseudoaneurysms of the labial artery, vaginal artery, and internal pudendal arteries.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of postpartum pseudoaneurysms (75%) are diagnosed within the uterine artery and lead to significant uterine bleeding [8]. There are rare reports of pseudoaneurysm rupture in alternate locations following obstetric delivery, including the vaginal artery, internal pudendal artery, and labial artery [9][10][11]. In each case, angiography and selective arterial embolization were used to successfully achieve cessation of postpartum hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

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Large vulvar hematoma secondary to obturator artery pseudoaneurysm following uncomplicated vaginal delivery: A case report and review of the literature

Paulina¹,

Miranda²

2021

J Case Rep Images Obstet Gynecol

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Introduction:Vulvovaginal hematoma and pseudoaneurysm of the pelvic vasculature are uncommon causes of postpartum hemorrhage. In this report we present the case of an obturator artery branch pseudoaneurysm causing puerperal vulvovaginal hematoma following uncomplicated vaginal delivery.Case Report: We present the case of a 27-year-old multiparous patient who underwent uneventful vaginal birth after cesarean (VBAC) following preterm premature rupture of membranes (PPROM) at 36w4d gestation. Within the immediate postpartum period she developed a rapidly expanding vulvar hematoma, with subsequent acute blood loss anemia and hypotension. Computed tomography (CT) angiogram of the pelvis showed a pseudoaneurysm of a branch of the right obturator artery, and she underwent successful coil embolization with interventional radiology. Incision and drainage was performed the following day with evacuation of the hematoma, and significant improvement in edema and pain. Conclusion:Obturator artery pseudoaneurysm is a rare cause of puerperal vulvovaginal hematoma that has not yet been described in the literature. We propose that CT angiography and arterial embolization should be considered in the setting of rapidly expanding puerperal vulvovaginal hematoma in a stable patient.

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Vaginal artery pseudoaneurysm after a hysterectomy: A case report and review of the literature

Zabihi,

Moeindarbari,

Khoroushi

et al. 2024

Clinical Case Reports

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Key clinical messageThis was the first report of a pseudoaneurysm in a vaginal artery after hysterectomy, unlike other published studies that were of pseudoaneurysms in uterine or vaginal arteries after delivery.AbstractA 51‐year‐old woman presented with massive vaginal bleeding 7 days after a hysterectomy, which caused hemoglobin to drop. The patient was suspicious of having a vaginal artery pseudoaneurysm according to the sonography. Her bleeding was stopped after the ligation of her left internal iliac artery.

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A ruptured vulvar labial artery pseudoaneurysm causes a secondary postpartum hemorrhage: A case report

Cited by 5 publications

References 7 publications

Endovascular management of episiotomy site hematoma: Two cases and a brief review

Endovascular management of episiotomy site hematoma: Two cases and a brief review

Large vulvar hematoma secondary to obturator artery pseudoaneurysm following uncomplicated vaginal delivery: A case report and review of the literature

Vaginal artery pseudoaneurysm after a hysterectomy: A case report and review of the literature

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