An uncommon cause of delayed postpartum hemorrhage is a pseudoaneurysm of the uterine artery. Pelvic arterial pseudoaneurysm is generally treated by laparotomy and hemostatic sutures or by uterine artery embolization. We describe two cases of late postpartum hemorrhage following Cesarean section, attributed to pelvic arterial pseudoaneurysm, that were successfully treated by direct thrombin injection under ultrasound guidance. Percutaneous or transvaginal ultrasound-guided direct thrombin injection is a simple procedure that does not require any sophisticated surgical or radiological equipment.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/uog.5139

Pelvic arterial pseudoaneurysm—a rare complication of Cesarean section: diagnosis and novel treatment

Apseudoaneurysm is an extraluminal collection of blood with turbulent flow that communicates with flowing arterial blood through a defect in the arterial wall. The development of an arterial pseudoaneurysm is a rare but reported complication of pelvic surgery or after vascular trauma. Hormonal and hemodynamic changes are considered the origins of this complication in pregnancy or puerperium. After hematoma formation there is central liquefaction of the hematoma, which leaves a cavity in which there is turbulent blood flow from a persistent communication between the parent artery and the hematoma. The absence of a 3-layer arterial wall lining the pseudoaneurysm differentiates it from a true aneurysm, which is less common than a pseudoaneurysm. 1-4 There is also a reported case of a pseudoaneurysm of the uterine artery associated with a leiomyoma without prior surgery or pregnancy. 5 Typically the lesions are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage. 4 A pseudoaneurysm may be asymptomatic, may thrombose, or may lead to distal painful embolization. The risk of rupture is proportional to the size and intramural pressure. Diagnosis is usually based on both Doppler sonography and arteriography 2,5 We report a case of a uterine artery pseudoaneurysm diagnosed 4 weeks after cesarean delivery, which ruptured before planned hysterectomy.

Pseudoaneurysm of the uterine artery after cesarean delivery: sonographic diagnosis and treatment.

Hemorrhage after myomectomy resulting from pseudoaneurysm of the uterine artery.

Conservative management of uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy and subsequent pregnancy outcome: case series and review of the literature

Recurrent bleeding from intercostal arterial pseudoaneurysm after retroperitoneal laparoscopic radical nephrectomy.

Pseudoaneurysm of the uterine artery after abdominal hysterectomy: radiologic diagnosis and management.

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Pseudoaneurysm of the uterine artery after abdominal hysterectomy: radiologic diagnosis and management.