Diagnosis and Management of Bilateral Uterine Arteries Aneurysm during Puerperium
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 2, Issue 2
Abstract
Postpartum hemorrhage remains one of the major causes of maternal morbidity and mortality. Secondary postpartum hemorrhage (PPH) is defined as excessive bleeding starting any time from 24 hours after delivery up to 12 weeks postpartum and most commonly occurring between 8 and 14 days postpartum. Common causes include retained products of conception, sub involution of the placental bed, and endometritis. Rare causes include pseudo aneurysm of uterine artery, arteriovenous malformations, and choriocarcinoma. Secondary PPH is rare. Until now secondary PPH has received very little attention probably because of its low incidence and because it causes more morbidity than mortality. However severe secondary PPH may sometimes become fatal [1]. A true aneurysm has all three layers of arterial wall, whereas pseudo aneurysm does not have all the three layers of arterial wall. Uterine artery pseudoaneurysms (UAP) are rare and potentially lifethreatening lesions. Their actual prevalence rate remains unknown. The UAPs may occur after using an intrauterine device, traumatic delivery, pregnancy termination, cesarean section, manual placenta removal, forceps delivery, vacuum extraction, or dilatation and curettage (D&C) [2]. The diagnosis of a uterine artery aneurysm can be made with ultrasound but when small, and when rupture has occurred, visualization may be difficult, CT scanning may be useful in identifying underlying arterial abnormality and it is often best demonstrated by angiography[3]. Arterial embolization should be considered as the treatment of choice for stable patients [4]. We report a case of left uterine artery aneurysm after an uncomplicated caesarean delivery in a patient with no surgical history. 25 years old lady, Para 1 was transferred to our hospital 55 days post her delivery, with symptoms of recurrent excessive vaginal bleeding ,she underwent category 1 caesarean delivery for fetal distress ,she was apparently asymptomatic for 35 days post operation , later she developed recurrent excessive vaginal bleeding ,and was admitted in hospital and diagnosed as case of endometritis and received intravenous antibiotics, she developed the same condition several times in which she was treated with same policy . In her last admission, D&C was done for the patient, but bleeding was not stop so laparotomy was done, compression of the uterus was done for 10 minute (bleeding was stopped) , she received 14 unit of blood ,and discharged in good condition. She was developed the same condition three times after the laparotomy, the last episode 6 days prior to her referring. Regarding her PMH, DH, FH were no significant.
Authors and Affiliations
Amir Elnahas, Mohammed Khidir Tayfoor, Salma Mohammed Hassan Eltayeb
Keywords
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- EP ID EP573209
- DOI 10.32474/IGWHC.2018.02.000131
- Views 84
- Downloads 0
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