Rupture of uterine artery pseudoaneurysm: role of ultrasonography in postpartum hemorrhage management

Abstract

Uterine artery pseudoaneurysm (UAP) rupture should be considered in case of late genital bleeding without obvious cause and lead to perform a sonographic examination with Doppler-scan. We report two cases of late post-partum hemorrhage from UAP diagnosed as such using color Doppler US. In order to avert life-threatening bleeding, prompt and accurate diagnosis should be made using color Doppler US since the latter plays a significant role in demonstrating the vascular nature of this anechoic uterine lesion.

Ultrasonographic Findings of Uterine Artery Pseudoaneurysm

“…The utilization of color Doppler seems to assist the confirmed diagnosis of UAP. Within the UAP, in addition, swirling arterial flow with different directions and velocities has been reported to be observed like the current case [2]. We present here a case of UAP following emergency CS diagnosed by ultrasonography.…”

“…Pseudoaneurysm is a dilation of an artery with partial or full disruption of the vessel wall [1][2][3][4]. Uterine artery pseudoaneurysm (UAP) is rare but a potentially life-threatening lesion.…”

“…Although many clinical interventions have been postulated to be responsible for development of UAP, cesarean section (CS) has seemed to be the most frequent cause of UAP because CS has possibilities of causing vessel injuries involving branches of uterine arteries [3]. The initial usefulness of ultrasonography for suspecting UAP has been well documented [1,2,4]. The unexpected appearance of uterine anechoic lesions at ultrasonography can suggest the presence of UAP.…”

Hysteroscopy to identify retained placental tissue and excision in secondary post-partum haemorrhage

“…21 Karmous N et al, described two cases of late post-partum hemorrhage from uterine artery pseudoaneurysm, (UAP) diagnosed as such using color doppler US, UAP illustrates a rare vascular complication after caesarean section. 6 UAP has been reported after hysterectomy and myomectomy also. Ligation of the uterine artery during the surgical procedures can lead to aneurysmal dilatation and formation of pseudoaneurysms.…”

“…Other rare causes of secondary PPH are, vessel subinvolution (VSI) of the placental implantation site, uterine artery pseudoaneurysm (UAP). 5,6 Secondary PPH due to dehiscence of caesarean section scar have been reported by many. 7,8 In the management of secondary PPH, the various surgical procedures adopted were, uterine evacuation, uterine tamponade balloon, uterine compression sutures, hysterectomy, pelvic arterial ligation, radiological intervention -selective arterial embolization.…”