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Abstract
Discussion Forum (0)
Introduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum hemorrhage (PPH), with prevalence ranging from 0.03-3 in 1000 deliveries. Presentation of UAP can vary from increased vaginal bleeding to life threatening hemorrhage and is often misdiagnosed as more common causes of PPH. We present a case of UAP and review management options.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Introduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum hemorrhage (PPH), with prevalence ranging from 0.03-3 in 1000 deliveries. Presentation of UAP can vary from increased vaginal bleeding to life threatening hemorrhage and is often misdiagnosed as more common causes of PPH. We present a case of UAP and review management options.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Uterine Artery Embolization for Postpartum Uterine Artery Pseudoaneurysm
Dr. Monica Purmalek
Affiliations:
Brooke Army Medical Center
Brooke Army Medical Center
Abstract
Discussion Forum (0)
Introduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum hemorrhage (PPH), with prevalence ranging from 0.03-3 in 1000 deliveries. Presentation of UAP can vary from increased vaginal bleeding to life threatening hemorrhage and is often misdiagnosed as more common causes of PPH. We present a case of UAP and review management options.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Introduction: Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum hemorrhage (PPH), with prevalence ranging from 0.03-3 in 1000 deliveries. Presentation of UAP can vary from increased vaginal bleeding to life threatening hemorrhage and is often misdiagnosed as more common causes of PPH. We present a case of UAP and review management options.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
Methods: Case Presentation
A 26yo G4P2022 status post spontaneous vaginal delivery presented at 4 weeks post-partum with heavy vaginal bleeding for one day. Transvaginal ultrasound (TVUS) at that time was concerning for significant blood clots with possible retained products of conception in the uterus and the patient was taken to the operating room for an uncomplicated suction dilation and curettage. Pathology from the procedure revealed tissue consistent with subinvolution of her placenta site without retained products of conception. The patient subsequently re-presented at 6 weeks post-partum with continued heavy vaginal bleeding. TVUS was concerning for uterine arteriovenous malformation versus pseudoaneurysm with evidence of a “yin-yang” sign. Interventional radiology ultimately performed a bilateral uterine artery embolization (UAE) with gelfoam on a 1.6x1.1x1.1cm UAP with resolution of the patient’s bleeding.
Results: Case Report
Conclusion/Implications: UAP is a rare cause of postpartum hemorrhage that can be life threatening especially if mismanaged. Management options are limited by patient stability and desire for future fertility. Uterine artery embolization is a safe and effective option for management of women with UAP that can be considered even when the patient desires future fertility.
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