Massive Secondary Postpartum Hemorrhage with Uterine Artery Pseudoaneurysm after Cesarean Section

Abstract

Uterine artery pseudoaneurysm is a rare but serious complication of cesarean section. If inadequately treated, it can lead to life-threatening postpartum hemorrhage. Herein, we report the case of a 28-year-old woman who developed secondary postpartum hemorrhage resulting from uterine artery pseudoaneurysm and cesarean scar dehiscence after cesarean section. Angiographic embolization is a safe and effective procedure for treating postpartum hemorrhage resulting from pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the surgical procedure of choice for hemodynamically unstable patients when fertility preservation is desired.

Secondary postpartum haemorrhage with uterine artery pseudoaneurysm after caesarean section, managed with uterine artery embolisation

“…The surgical approach may be more suitable in cases of acute and massive bleeding in which there is no time for embolisation, and may depend on the specific resources available in each institution. [2] With newer modalities of treatment becoming available, hysterectomy for postpartum haemorrhage should be a last resort. Injuries to the vessel are more likely during a C/S, which could subsequently give rise to a PA. Doppler ultrasound and angiography are useful techniques to diagnose this condition.…”

“…[2] Haematoma formation involving the uterine artery is the main suggested mechanism associated with PA of the uterine artery. After haematoma formation, there is central liquefaction that leaves a cavity with turbulent blood flow as a result of persistent communication between the parent artery and the hematoma.…”

“…[1] Although a diagnosis of retained gestational products or endometritis should be considered initially, a diagnosis of PA of the uterine artery and caesarean scar dehiscence should be considered after ruling out disseminated intravascular coagulation as a possible diagnosis when a patient presents with massive uterine bleeding without any associated symptoms, such as fever and tenderness, or subinvolution of the uterus. [2] Haematoma formation involving the uterine artery is the main suggested mechanism associated with PA of the uterine artery. After haematoma formation, there is central liquefaction that leaves a cavity with turbulent blood flow as a result of persistent communication between the parent artery and the hematoma.…”

Conservative treatment of giant uterine artery pseudoaneurysm

“…A pseudoaneurysm is an extraluminal collection of arterial blood, with turbulent flow, that results from blood flowing through a defect in an arterial wall. Uterine artery pseudoaneurysm (UAP) is a rare but life‐threatening complication of uterine surgery such as Cesarean section. It may be asymptomatic, may thrombose or may rupture, resulting in secondary postpartum hemorrhage (PPH).…”

“…Uterine artery pseudoaneurysm (UAP) is a rare but life‐threatening complication of uterine surgery such as Cesarean section. It may be asymptomatic, may thrombose or may rupture, resulting in secondary postpartum hemorrhage (PPH). The incidence of ruptured UAP has been estimated to be about 3% of all patients presenting with PPH.…”