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Bilateral uterine artery embolization for the management of bilateral uterine artery pseudoaneurysm during puerperium: A case report


MOJ Women's Health
Sally Damra Elnour Mohammed,1 Mohammed Khidir Tayfor,2 Isra Mutasim Hamad,1 Mashaar Osama1

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Abstract

Background Uterine artery Pseudoaneurysm is a rare cause of secondary postpartum hemorrhage (PPH) and can develop after various gynecological or obstetric procedures. The delayed diagnosis of such cases often results in life threatening situations. We report a rare case of bilateral uterine arteries pseudoaneurysm that led to life threatening secondary PPH after Caesarean section in a patient who had several Caesarean sections before.

Case description: A 35 years old multiparus women, who had all her four deliveries by Caesarean sections, presented with recurrent massive attacks of secondary PPH 35ays after her last delivery. Rupture of aneurysm of the uterine artery was suspected and CT angiography showed that the left uterine artery seemed more dilated and was probably the source of the PPH. The bleeding site was successfully tackled by selective arterial embolization. About three weeks later the patient presented again with severe recurrence of her PPH. Repeat of CT angiography showed that the source was the right uterine artery this time, which was again selectively embolized. No further bleeding events occurred up to two years follow-up.

Conclusion: Rupture of aneurysm of the uterine artery can be a life-threatening condition. Clinical suspicion is essential for a prompt diagnosis Definitive diagnosis can be achieved by CT-angiography. Treatment by selective embolization can effectively stop the bleeding.

Keywords

Postpartum hemorrhage, pseudoaneurysm, angiography, embolization

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