title: Concealed postpartum hemorrhage treated with transcatheter arterial embolization.
abstract: BACKGROUND
  Postpartum hemorrhage is an obstetric emergency and is a major preventable cause of maternal morbidity and mortality. An arteriovenous fistula is a rare cause of concealed postpartum hemorrhage.
  
  
  METHODS
  A 20-year-old woman spontaneously delivered at 40 0/7 weeks of gestation. Twelve hours after delivery, she became hemodynamically unstable, developing a large left vaginal hematoma. An angiogram revealed extravasation originating from the right pudendal artery with early filling of a draining vein, consistent with a traumatic arteriovenous fistula. Complete occlusion of the fistula was achieved by embolizing a branch of the right pudendal artery. The postprocedure course was uneventful.
  
  
  CONCLUSIONS
  A vaginal arteriovenous fistula should be considered in cases of concealed postpartum hemorrhage; transcatheter arterial embolization is an effective treatment for these cases.
authors: From the Department of Obstetrics and Gynaecology, Mount Sinai Hospital, the University of Toronto, and the Departments of Vascular and Interventional Radiology, University Health Network and Mount Sinai Hospitals, Toronto, Canada.
authors: Leslie K
authors: LK
authors: Po
authors: Martin E
authors: ME
authors: Simons
authors: Elyse S
authors: ES
authors: Levinsky
mesh_terms: D000328:Adult; D000792:Angiography; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000628:therapy; D002404:Catheterization; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications; D014057:Tomography, X-Ray Computed; D014623:Vaginal Diseases / Q000175:diagnosis*; D055815:Young Adult