title: Ruptured uterine artery pseudoaneurysm: an overlooked cause of late postpartum haemorrhage.
abstract: We report an exceptional case of secondary postpartum hemorrhage (PPH) twenty days after cesarean delivery, resulting from a ruptured uterine artery pseudoaneurysm (UAP). The diagnosis was initially confounded by a septic shock necessitating inotropic support in the intensive care unit. Intense vaginal bleeding occurred eleven days after uterine curettage. Doppler ultrasound showed an anechoic focus in the inferior part of the uterus with turbulent flow. Bilateral internal iliac artery angiograms revealed a left uterine artery pseudoaneurysm that was successfully embolized. UAP is a rare cause of unexplained PPH that requires a high index of suspicion for diagnosis. This first report in the anesthesia literature serves to focus our awareness on its possible occurrence, and gives track to its management. Pitfalls in UAP diagnostic are highlighted (delayed presentation, possibility of spontaneous hemostasis, and lack of typical findings on colour Doppler sonography in hypotensive patients). These pitfalls may further be confounded by a concomitant sepsis. Angiography and selective uterine artery embolization is the treatment of choice.
authors.affiliation: Department of Women's Anaesthesia, KK Women's & Children's Hospital, Singapore.
authors.forename: S S
authors.initials: SS
authors.lastname: Kulkarni
authors.affiliation: Department of Women's Anaesthesia, KK Women's & Children's Hospital, Singapore.
authors.forename: W H L
authors.initials: WH
authors.lastname: Teoh
authors.affiliation: Department of Women's Anaesthesia, KK Women's & Children's Hospital, Singapore.
authors.forename: A T H
authors.initials: AT
authors.lastname: Sia
authors.affiliation: Department of Obstetrics and Gynaecology, KK Women's & Children's Hospital, Singapore.
authors.forename: S
authors.initials: S
authors.lastname: Nair
mesh_terms: D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011859:Radiography; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055357:Uterine Artery Embolization / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole; D002443:Ceftriaxone