Postpartum hemorrhage caused by uterine artery pseudoaneurysm and uterine rupture after vaginal delivery

Abstract

A case of massive hemoperitoneum determined by uterine rupture and uterine artery pseudoaneurysm dissection after vaginal delivery, requiring an emergency laparotomy with arterial ligation, is reported. The authors reviewed the published literature, finding 12 cases of uterine artery pseudoaneurysm and associated postpartum hemorrhage after vaginal delivery, but no cases with uterine rupture have ever been published. Diagnosis is based upon imaging, and management options include arterial embolization, arterial ligation and hysterectomy in particularly severe and life-threatening situations. Vaginal bleeding is associated with favorable outcomes and conservative treatment, while the absence of external blood loss seems to be correlated with a worsened prognosis and the need for an invasive treatment option. Uterine artery pseudoaneurysm rupture after vaginal delivery is a very rare condition of life-threatening postpartum hemorrhage, being more frequently associated with cesarean section. Uterine artery pseudoaneurysm dissection should be suspected in any patient presenting with early or delayed postpartum hemorrhage after a vaginal delivery and can be associated with uterine rupture.