EP20.11: Rupture of uterine artery pseudoaneurysm: role of ultrasonography in postpartum hemorrhage management

Uterine artery pseudoaneurysm (UAP) rupture should be considered in case of late genital bleeding without obvious cause and lead to perform a sonographic examination with Doppler-scan. We report a case of late postpartum hemorrhage from UAP diagnosed as such using colour Doppler US. A 24-years-old woman with no previous disease history came to our emergency 32 days after Caesarean section because of abnormal uterine bleeding. On arrival at our emergency, massive uterine bleeding was observed and vital signs were unstable. The hemoglobin concentration was 5.3g/dL. Crystalloid solution was administered, and 3 units of concentrated red blood cells were transfused. Transvaginal US revealed an anechoic lesion at the uterine cervix measuring 13×11mm in diameter. Colour Doppler transvaginal US showed a spinning blood flow in the previously indicated anechoic structure. It also showed a “yin-yang” mosaic pattern indicating the presence of a pseudoaneurysm. However, no retained gestational products were detected. Patient was treated with bilateral internal iliac artery ligation because emergency transcatheter embolization was not available in our facility. The hemorrhage ceased and the course was uneventful. The patient was discharged 2 days later. The patient returned to our emergency 49 days after CS because of continuous abnormal uterine bleeding. On examination, there was profuse bleeding; vital signs remained stable. The hemoglobin concentration was 8 g/dL. An attempt was made to neutralise the uterine bleeding using the balloon of a urinary catheter. The bleeding decreased but was still present. It was decided to proceed with uterine artery embolization (UAE). UAE was successful, and complete hemostasis was achieved. The patient was discharged 4 days after embolization. She has had normal menstruation periods and no abnormal uterine bleeding since. No further lesion has been detected at transvaginal US.