Obstet Gynecol Sci.  2017 May;60(3):303-307. 10.5468/ogs.2017.60.3.303.

Delayed postpartum hemoperitoneum due to uterine artery pseudoaneurysm rupture

• Kyeong KS
• Moon JY
• Chae SH
• Hong SH
• Kang M
• Jeong EH

• KMID: 2378593
• DOI: http://doi.org/10.5468/ogs.2017.60.3.303

Abstract

A 30-year-old woman experienced severe abdominal pain 8 days after vaginal delivery. The patient was diagnosed with hemoperitoneum due to rupture of the left uterine artery pseudoaneurysm, which was confirmed via ultrasound with color Doppler and computed tomography scans. This patient was treated with bilateral uterine artery embolization to maintain fertility. A uterine artery pseudoaneurysm that causes delayed postpartum hemorrhage can occur after cesarean section or vaginal delivery. A uterine artery pseudoaneurysm can be fatal, so its detection and diagnosis are critical. Herein, we report a case of delayed postpartum hemoperitoneum due to uterine artery pseudoaneurysm rupture.

Keyword

Postpartum period; Hemoperitoneum; Aneurysm, false; Embolization

MeSH Terms

Abdominal Pain
Adult
Aneurysm, False*
Cesarean Section
Diagnosis
Female
Fertility
Hemoperitoneum*
Humans
Postpartum Hemorrhage
Postpartum Period*
Pregnancy
Rupture*
Ultrasonography
Uterine Artery Embolization
Uterine Artery*

Figure

• 

  Fig. 1 (A) Transvaginal gray scale sonograms showing a hypoechoic lesion (arrow) in the myometrium of the left lower segment of the uterus. (B) Color Doppler signals showing the typical arterial ‘to-and-fro’ pattern.

• 

  Fig. 2 Computed tomography revealed (A) leakage of contrast media (arrow) from the left uterine artery (before embolization), (B) no evidence of contrast media leakage (after embolization).

Reference

1. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics. 24th ed. New York (NY): McGrawHill;2014.

2. Zimon AE, Hwang JK, Principe DL, Bahado-Singh RO. Pseudoaneurysm of the uterine artery. Obstet Gynecol. 1999; 94:827–830.

3. Baba Y, Matsubara S, Kuwata T, Ohkuchi A, Usui R, Saruyama M, et al. Uterine artery pseudoaneurysm: not a rare condition occurring after non-traumatic delivery or non-traumatic abortion. Arch Gynecol Obstet. 2014; 290:435–440.

4. Lee WK, Roche CJ, Duddalwar VA, Buckley AR, Morris DC. Pseudoaneurysm of the uterine artery after abdominal hysterectomy: radiologic diagnosis and management. Am J Obstet Gynecol. 2001; 185:1269–1272.

5. Nanjundan P, Rohilla M, Raveendran A, Jain V, Khandelwal N. Pseudoaneurysm of uterine artery: a rare cause of secondary postpartum hemorrhage, managed with uterine artery embolisation. J Clin Imaging Sci. 2011; 1:14.

6. Soyer P, Fargeaudou Y, Morel O, Boudiaf M, Le Dref O, Rymer R. Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur Radiol. 2008; 18:1181–1187.

7. Gondo S, Urushiyama D, Yoshizato T, Kora S, Maehara M, Kondo H, et al. The successful detection of postpartum unruptured vaginal pseudoaneurysm using ultrasonography: a case report. Springerplus. 2014; 3:482.

8. Kwon HS, Cho YK, Sohn IS, Hwang HS, Seo KJ, Park WI, et al. Rupture of a pseudoaneurysm as a rare cause of severe postpartum hemorrhage: analysis of 11 cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2013; 170:56–61.

9. Yi SW, Lee JH. Uterine pseudoaneurysm leakage may cause delayed postpartum haemorrhage: multidetector CT with angiography and transcatheter uterine arterial embolisation. J Obstet Gynaecol. 2012; 32:552–555.

10. Yun SY, Lee DH, Cho KH, Lee HM, Choi YH. Delayed postpartum hemorrhage resulting from uterine artery pseudoaneurysm rupture. J Emerg Med. 2012; 42:e11–e14.

11. Gurses C, Yilmaz S, Biyikli S, Yildiz IO, Sindel T. Uterine artery pseudoaneurysm: unusual cause of delayed postpartum hemorrhage. J Clin Ultrasound. 2008; 36:189–191.

12. McGonegle SJ, Dziedzic TS, Thomas J, Hertzberg BS. Pseudoaneurysm of the uterine artery after an uncomplicated spontaneous vaginal delivery. J Ultrasound Med. 2006; 25:1593–1597.

13. Henrich W, Fuchs I, Luttkus A, Hauptmann S, Dudenhausen JW. Pseudoaneurysm of the uterine artery after cesarean delivery: sonographic diagnosis and treatment. J Ultrasound Med. 2002; 21:1431–1434.

14. Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, et al. Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. Cardiovasc Intervent Radiol. 2015; 38:1068–1081.

15. Cooper BC, Hocking-Brown M, Sorosky JI, Hansen WF. Pseudoaneurysm of the uterine artery requiring bilateral uterine artery embolization. J Perinatol. 2004; 24:560–562.