Secondary postpartum hemorrhage due to uterine artery pseudoaneurysm rupture in von Willebrand disease

Shimizu, Morihito; Kondoh, Eiji; Ueda, Masashi; Kakui, Kazuyo; Tatsumi, Kazuyoshi; Konishi, Ikuo

doi:10.1111/j.1447-0756.2011.01674.x

Cited by 10 publications

(16 citation statements)

References 11 publications

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“…However, it is possible that uterine arteries may have some abnormalities, or at least vulnerability to D&C. In addition, the presence of coagulopathy and/or hemorrhagic diathesis (Kasabach–Merritt syndrome) may have contributed to the occurrence of UAP; the strength of the vasculature requires intact coagulation factors. Indeed, some previous reports have indicated that underlying disorders were present and contributed to the occurrence of pseudoaneurysm: coagulopathy/hemorrhagic diathesis (von Willebrand disease) [3] and vascular abnormalities (Ehlers–Danlos syndrome) [4], which coexisted in the present patient.…”

Section: Conflict Of Interestmentioning

confidence: 49%

Uterine artery pseudoaneurysm after dilation and curettage in a woman with multiple hepatic and pulmonary cavernous hemangiomas

Matsubara¹,

Nonaka²,

Kobayashi³

et al. 2014

Intl J Gynecology & Obste

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S. Matsubara).Fig. 1. Uterine artery pseudoaneurysm and multiple hepatic and pulmonary cavernous hemangiomas. (a) Ultrasound findings show that the uterine cavity is occupied by an echogenic mass (star), indicative of hematoma, in which a small anechoic area with flow (short arrows) can be observed. The area marked by a long arrow has pulsatile flow, indicative of arterial flow (right panel). (b) Computed tomography image of the uterus at an early phase after enhancement. The uterine cavity is occupied by hematoma (double arrows), and a small nodular enhancement (arrow) can be seen within it, indicating turbulent flow. (c) Computed tomography image of the liver and the lungs. Multiple masses, some well enhanced, are evident in the liver (black arrow) and the lungs (white arrow). Some masses have calcifications, indicating phleboliths, which are frequently seen in hemangioma. A huge hepatic hemangioma can be seen (star). (d) Selective angiography showing extravasation (short arrows) from the left uterine artery (long arrow).Uterine artery pseudoaneurysm (UAP)-which may occur secondary to tubal surgery [1]-can cause postpartum hemorrhage, especially after cesarean delivery. We report a case of UAP occurring after uneventful dilation and curettage (D&C) in a woman with multiple hepatic and pulmonary cavernous hemangiomas. Informed consent for reporting was obtained from the patient.A 29-year-old nulliparous woman experienced incomplete abortion at 6 weeks. Ultrasound showed a normal-appearing uterus with an empty gestational sac (20-mm diameter). Color Doppler showed no abnormal uterine artery flow or structure. The woman underwent uneventful D&C; 8 days later, massive hemorrhage occurred. Chest X-ray had revealed multiple pulmonary nodules when the patient was 15 years of age. Computed tomography (CT) revealed multiple masses with a progressive centripetal enhancement in both the liver and the lungs: a characteristic finding of cavernous hemangioma. Biopsy confirmed this diagnosis. Computed tomography revealed no hemangiomas in the pelvic cavity.The woman experienced vaginal hemorrhage with mild anemia (hemoglobin 98 g/L) and coagulation disorders (platelets 77 × 10 9 /L; fibrinogen 0.57 g/L; fibrinogen/fibrin degradation product 708 mg/L; D-dimer 132 mg/L). Ultrasound revealed that the uterine cavity was occupied by an echogenic mass with a small anechoic area with turbulent flow (Fig. 1a); CT revealed an intrauterine mass with no enhancement and a mass with a small nodular enhancement (Fig. 1b), in addition to multiple hemangiomas in the lungs and the liver (Fig. 1c). The presence of hemangiomas and coagulation disorders indicated Kasabach-Merritt syndrome. Pelvic angiography showed extravasation from the left 84 BRIEF COMMUNICATIONS

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Section: Conflict Of Interestmentioning

confidence: 49%

Uterine artery pseudoaneurysm after dilation and curettage in a woman with multiple hepatic and pulmonary cavernous hemangiomas

Matsubara¹,

Nonaka²,

Kobayashi³

et al. 2014

Intl J Gynecology & Obste

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“…According to a prospective study, failure of thrombosis was associated with considerably large PAs and the concomitant use of anticoagulation or antiplatelet agents [6]. Furthermore, late postpartum hemorrhage due to ruptured PA also occurs in patients with von Willebrand disease [7,8]. In general, PAs are thrombosed spontane-ously.…”

Section: Discussionmentioning

confidence: 99%

“…In general, PAs are thrombosed spontane-ously. Therefore, PA is formed as a result of repeated bleeding and thrombus due to abnormal hemostasis [4][5][6][7][8]. Hence, an underlying bleeding disorder or anticoagulation therapy should be considered in patients presenting with PA rupture-induced postpartum hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Development of Vaginal Pseudoaneurysm 3 Years after Cesarean Section Possibly Induced by Anticoagulant and Antiplatelet Therapies

Kinjo

Mekaru

et al. 2020

Case Reports in Obstetrics and Gynecology

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Pseudoaneurysms generally develop when an arterial puncture site is inadequately sealed. We encountered a case of vaginal pseudoaneurysm that developed 3 years after cesarean section in a 35-year-old gravida 7 para 4 woman who was prescribed with anticoagulant and antiplatelet drugs after surgeries for ventricular septal defect and aortic valve replacement. Pelvic computed tomography scan revealed a large mass, which showed a dappled contrast filling on the arterial phase, located in the posterior vaginal wall. The vaginal pseudoaneurysm was completely occluded by embolization of the left vaginal artery. Anticoagulation and antiplatelet therapies can be potential causes of spontaneous pseudoaneurysm rupture. Extrauterine pseudoaneurysm has a long period of time between cesarean section and pseudoaneurysm discovery. Considering that pseudoaneurysm shows different clinical features for each patient, we should always consider pseudoaneurysm when we assess a patient with postpartum hemorrhage.

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“…A UAP appears as a saclike structure within the uterus with a connection to the uterine artery. 23,25,26 Conservative treatment may be to monitor the pseudoaneurysm if it has not ruptured, because pseudoaneurysms have been reported to resolve spontaneously. 27 Rupture is prone to occur if the UAP diameter exceeds 2 cm.…”

Section: Discussionmentioning

confidence: 99%

Postpartum Pseudoaneurysm After Cesarean Delivery

DiGiacinto

Bagley

Gildon

et al. 2018

Journal of Diagnostic Medical Sonography

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Uterine artery pseudoaneurysm is an uncommon vascular lesion that can be life threatening. A ruptured uterine artery pseudoaneurysm can cause acute massive hemorrhaging, creating a true emergency for the postpartum patient. The etiology is more commonly seen with traumatic procedures such as cesarean delivery or curettage. This case report is of a patient with a history of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome who presented with heavy bleeding after a cesarean delivery. Sonography was primarily used to diagnose the uterine artery pseudoaneurysm. Because of the massive hemorrhaging in this case, a hysterectomy was performed.

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Secondary postpartum hemorrhage due to uterine artery pseudoaneurysm rupture in von Willebrand disease

Cited by 10 publications

References 11 publications

Uterine artery pseudoaneurysm after dilation and curettage in a woman with multiple hepatic and pulmonary cavernous hemangiomas

Uterine artery pseudoaneurysm after dilation and curettage in a woman with multiple hepatic and pulmonary cavernous hemangiomas

Development of Vaginal Pseudoaneurysm 3 Years after Cesarean Section Possibly Induced by Anticoagulant and Antiplatelet Therapies

Postpartum Pseudoaneurysm After Cesarean Delivery

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