Delayed postpartum hemoperitoneum due to uterine artery pseudoaneurysm rupture

Kyeong, Kyu-Sang; Moon, Ji-Yeon; Chae, Song-Hwa; Hong, Seung Hwa; Kang, Minho; Jeong, Eun-Hwan

doi:10.5468/ogs.2017.60.3.303

Cited by 4 publications

(3 citation statements)

References 14 publications

(27 reference statements)

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“…As in our case, pseudoaneurysm of uterine artery has been seen following caesarean section 3. It has also been reported as a complication following dilatation and curettage,2 myomectomy,4 hysterectomy,5 oocyte retrieval for in vitro fertilisation and even after uncomplicated vaginal delivery 6. Typically, patients develop symptoms due to delayed rupture of pseudoaneurysms causing haemorrhage as was seen in our case.…”

Section: Discussionsupporting

confidence: 73%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 73%

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

et al. 2021

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“…Two types of UAPs have been reported: one that communicates with the uterine cavity and causes vaginal bleeding, and another with no communication and results in hematoma formation outside the uterus. The main clinical manifestation of UAP has been reported as abnormal vaginal bleeding, with a few patients reporting abdominal pain [11] or intra-abdominal bleeding [12]; however, it can also present with no obvious clinical manifestations. The presentation can vary from insidious bleeding to paroxysmal massive vaginal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of patients with rare uterine artery pseudoaneurysm: seven case series and review of the literature

tong,

xiao,

2023

Preprint

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Background Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening complication of traumatic pelvic operations and non-traumatic delivery/abortion. Due to the lack of awareness, UAP is often diagnosed after the occurrence of paroxysmal massive vaginal bleeding. Methods This was a retrospective study of seven patients with UAP in the West China Second University Hospital from January 2018 to August 2022. Results In this study, the average age of seven patients was 26.71 years. Six patients presented with a history of traumatic surgery, including cesarean scar pregnancy (CSP) (two patients), curettage for abortion (one patient), laparoscopic myomectomy (one patient), cervical conization (one patient), and curettage for gestational trophoblastic disease (one patient). The seventh patient underwent second-trimester pregnancy termination without a traumatic surgical procedure. The main symptom reported in patients was vaginal bleeding: three patients had paroxysmal massive vaginal bleeding amounting to more than 2000 mL. All the patients were confirmed using magnetic resonance imaging (MRI). Five patients underwent uterine artery embolization, and two patients were managed conservatively. One patient had massive vaginal bleeding again after bilateral transarterial embolization,MRI showed that the left UAP still existed, and finally transabdominal left internal iliac artery ligation and pseudoaneurysm resection were performed. All patients had good outcomes. Conclusions Seven patients with UAP were reviewed in this study, with their characteristic clinical symptoms, previous pelvic surgery, imaging features, treatment approaches, and prognosis described in detail and analyzed, hoping to provide new insights for the diagnosis or treatment of this rare life-threatening complication.

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“…Eriksson et al followed up patients after interventional treatment of uterine artery pseudoaneurysm and observed no case of infertility after embolization 6 . Embolization may also be performed bilaterally in women with massive bleeding 7 . In resource‐limited settings, surgical uterine artery ligation is an alternative to preserve fertility 8 .…”

Section: Discussionmentioning

confidence: 99%

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

Pohlan

Hinkson

Wickmann

et al. 2020

J of Clinical Ultrasound

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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.

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Delayed postpartum hemoperitoneum due to uterine artery pseudoaneurysm rupture

Cited by 4 publications

References 14 publications

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

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

Diagnosis and treatment of patients with rare uterine artery pseudoaneurysm: seven case series and review of the literature

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

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