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Postpartum hemorrhage secondary to pseudoaneurysm of the uterine artery – A case report

Vanessa Marie Ty Lim, MD; Thelma Marie Avendano Elio MD, FPOGS
Department of Obstetrics and Gynecology, St. Luke’s Medical Center - Quezon City

Obstetric hemorrhage is the most important cause of maternal mortality worldwide approximately 27.1%. Pseudoaneurysm of the uterine artery is rare but a potentially life-threatening complication reported to occur. In the Philippines, experience with these kinds of vascular abnormalities is limited. This is a case of a 26-year old Gravida 2 Para 1 (1011) eight weeks post-cesarean section with profuse vaginal bleeding. Transvaginal ultrasonography with doppler revealed arterio-venous malformation of the cervix with high arterial pulsations. Pelvic angiography revealed brisk contrast extravasation and pooling at the fundal branch of the left uterine artery consistent with pseudoaneurysm for which she successfully underwent superselective coil embolization. Repeat ultrasonography after one week showed absence of arterial pulsations on the cervical echogenicity. Despite a recent proliferation of reports, uterine artery pseudoaneurysm still remains to be a rare cause of unexplained postpartum hemorrhage, which requires a high index of clinical suspicion for diagnosis.