title: Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization.
abstract: The purpose of this retrospective study was to evaluate the role of transcatheter arterial embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter arterial embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter arterial embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter arterial embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter arterial embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm.
authors.affiliation: Department of Abdominal Imaging, Hopital Lariboisière-AP-HP Université Paris 7, 2, rue Ambroise Paré, 75475 Paris cedex 10, France. philippe.soyer@lrb.ap-hop-paris.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Soyer
authors.forename: Yann
authors.initials: Y
authors.lastname: Fargeaudou
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
authors.forename: Mourad
authors.initials: M
authors.lastname: Boudiaf
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Dref
authors.forename: Roland
authors.initials: R
authors.lastname: Rymer
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014593:Uterine Inertia; D014599:Uterus / Q000098:blood supply*