Pseudoanaeurysm of right uterine artery: Rare cause of secondary postpartum hemorrhage (PPH) & managed by uterine artery embolisation

Kavitha Naragoni, Shirisha G, Chalapathi Rao MV

Pdf Page Numbers :- 13-16

 Kavitha Naragoni^1,*, Shirisha G¹ and Chalapathi Rao MV²

¹Department of Obstetrics & Gynecology, Krishna Institute of Medical sciences, Minister Road, Secunderabad - 500003, AP, India

²Department of Radiology & Imageology, Krishna Institute of Medical sciences, Minister Road, Secunderabad - 500003, AP, India

*Corresponding author: Dr. Kavitha Naragoni, MBBS, DGO, FCGP, Consultant Gynaecologist, Department of Obstetrics & Gynecology, Krishna Institute of Medical sciences, Minister Road, Secunderabad - 500003, AP, India.

Received 25 September 2013; Revised 23 December 2013; Accepted 30 December 2013

Citation: Kavitha Naragoni, Shirisha G, Chalapathi Rao MV. Pseudoanaeurysm of right uterine artery: Rare cause of secondary postpartum hemorrhage (PPH) & managed by uterine artery embolisation. J Med Sci Res 2014; 2(1):13-16. DOI: http://dx.doi.org/10.17727/JMSR.2014/2-002

Copyright: © 2014 Kavitha Naragoni et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

 A 24 yrs-old woman (G1P1) had an uneventful first pregnancy, delivered by emergency caesarian section at term. The patient was transferred to our institution on 24^th postoperative day with symptoms of severe bleeding per vaginum with syncopal attacks of two episodes. On examination, her vitals were stable, the C- section scar was healthy and uterus well retracted and cervical OS closed with minimal bleeding. Her hemoglobin was 6.1gm/dl and 1 unit of compatible packed cell transfusion was given and broadspectrum antibiotics were started. Trans vaginal ultrasound scan (TVS) with color doppler was done. It confirmed postpartum uterus without any evidence of retained products of conception. Endometrial thickness was 7 mm. A hypoechoic lesion of size 1.7 x 1.0 cm with ‘yin and yang’ blood flow pattern was detected, posteroinferior to the site of scar in the lower segment, suggestive of pseudoaneurysm. CT angiography was done and it was confirmed as pseudoaneurysm of distal branches of right uterine artery. To preserve fertility, right uterine artery and pseudoaneurysm were selectively cannulated and embolization of pseudoaneurysm was performed using N-Butylcyano Acrylate with lipoidol mixture. A post embolization angiographic study was performed to ensure complete exclusion of aneurysm from circulation. She was asymptomatic on follow-up. Doppler and CT angiography are useful techniques to diagnose this condition. Being a minimally invasive procedure selective embolization should be done whenever feasible.

Keywords: Pseudoanaeurysm; Uterine artery; Secondary postpartum hemorrhage