Rupture of uterine artery pseudoaneurysm after cesarean section

Abstract

Postpartum hemorrhage is an important cause of maternal mortality. The rupture of a uterine artery pseudoaneurysm, a rare vascular lesion of unknown prevalence, produces secondary postpartum hemorrhage without an evident cause. If not properly diagnosed and treated, it can be life threatening. Etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. Its clinical presentation is varied and often associated with other more frequent gynecological and obstetric pathologies. Patients may present no symptoms, vaginal bleeding or even postpartum hemorrhage and hypovolemic shock. To prevent fatal bleeding, a rapid and accurate diagnosis must be made, based on non-invasive imaging studies. Angiographic embolization is a safe and effective method to control hemorrhage in hemodynamically stable patients and should be an option before resorting to surgery in selected cases. We describe a case of rupture of uterine artery pseudoaneurysm following a cesarean section.