Uterine artery pseudoaneurysm as a cause of secondary postpartum haemorrhage following a caesarean section

Abstract

Postpartum haemorrhage (PPH) is a major direct cause of maternal mortality worldwide, and primary PPH accounts for most of these deaths. Secondary PPH is not usually as catastrophic and certainly less frequent but may still cause significant morbidity, and if not appropriately managed, can also lead to maternal death. The common causes of secondary PPH include subinvolution of the placental site, retained products of conception and endometritis. Rare causes such as uterine or cervical neoplasms as well as vascular abnormalities including uterine artery pseudoaneurysm, should be excluded, especially in patients not responding to uterotonics and antibiotics. Traditionally the treatment of uterine artery pseudoaneurysms would warrant a surgical approach, but recently selective uterine artery embolization (UAE) has become the treatment of choice. Ultrasound-guided thrombin injection of these vascular anomalies has also been successfully used in appropriate cases. With the availability of these uterine-preserving techniques, clinicians should perhaps consider UAE in the haemodynamically stable patient before resorting to surgery.