EP19.18: Increasing incidence of delayed postpartum hemorrhage attributed to uterine artery pseudoaneurysm: a call for routine imaging follow‐up

This thesis explores the rising incidence of delayed postpartum hemorrhage (PPH) due to uterine artery pseudoaneurysm and proposes a routine checkup as a potential solution. It aims to highlight the underreported incidence of pseudoaneurysm as a significant contributor to late PPH and to advocate for enhanced diagnostic protocols to improve maternal health outcomes. The thesis synthesises data from retrospective analyses of delayed PPH cases over the past decade (Jan. 2013 ~ Dec. 2023), focusing on those attributed to uterine artery pseudoaneurysm. Twenty-nine patients with uterine artery pseudoaneurysm were retrieved from the patients who underwent arterial embolization. clinical profiles, and angiographic examinations were reviewed. Nineteen patients had Caesarean section, seven patients had D&C and three patients had vaginal delivery previous to the event. All patients had an estimated blood loss of more than 1,000mL. The mean hemoglobin level was 10.2 g/dL (range: 6.9-14.1). Most of the patients had received packed red blood cells (mean = 2.48, range: 0-8). The analysis indicates a notable increase in delayed PPH cases attributed to uterine artery pseudoaneurysm, with a significant portion identified only upon the manifestation of severe symptoms or in the course of treatment for delayed PPH. The rising incidence of PPH attributed to uterine artery pseudoaneurysm underscores the need for systematic diagnostic follow-up protocols, not only ultrasonography but also CT angiography based on individual risk assessments. Implementing such protocols could lead to earlier detection, timely interventions, and ultimately, better maternal health outcomes. This thesis advocates for further research into tailored follow-up strategies as a standard of care for women at risk of uterine artery pseudoaneurysm.