Pelvic arterial pseudoaneurysm—a rare complication of Cesarean section: diagnosis and novel treatment

Abstract

An uncommon cause of delayed postpartum hemorrhage is a pseudoaneurysm of the uterine artery. Pelvic arterial pseudoaneurysm is generally treated by laparotomy and hemostatic sutures or by uterine artery embolization. We describe two cases of late postpartum hemorrhage following Cesarean section, attributed to pelvic arterial pseudoaneurysm, that were successfully treated by direct thrombin injection under ultrasound guidance. Percutaneous or transvaginal ultrasound‐guided direct thrombin injection is a simple procedure that does not require any sophisticated surgical or radiological equipment. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization

“…Although our series does not contain sufficient material to allow us to draw conclusions upon the most appropriate embolic material, it may be reasonable to suggest that gelatin sponge is an efficient embolic material for the treatment of ruptured pseudoaneurysm in a subset of patients. Recently, an alternate treatment option has been reported by Kovo et al, who described the use of direct thrombin injection into the pseudoaneurysm using ultrasonographic guidance in patients with postpartum haemorrhage due to a pseudoaneurysm [30].…”

Sonographic diagnosis of postpartum pseudoaneurysms of the uterine artery: A report of 2 cases

“…Heavy bleeding may also occur into the retroperitoneal space. 11,12 Color Doppler imaging has been used to diagnose vascular abnormalities, but there is little information concerning other circulatory parameters. In both our cases, the peak systolic velocity in the feeding artery was high.…”

“…Currently, embolization is the most commonly used treatment, but percutaneous thrombin injections have also been tried. 12 3D US enabled calculation of the volume of the unilocular PA in our 2 nd case. As yet, the association between the volume of a pelvic PA and the risk of bleeding has not been investigated, in contrast to intracranial true aneurysms, in which a larger size is associated with a worse prognosis.…”

Pseudo aneurysm of uterine artery and cesarean scar dehiscence causing secondary post-partum haemorrhage managed by uterine artery embolisation: a case report

“…14 Uterine artery embolisation offers the advantage of localization of exact bleeding site, decreased morbidity and duration of hospital stay, more distal occlusion than surgical ligation of artery, no need of general anesthesia, repeat embolisation if needed can be performed and preservation of future fertility.…”