Cause Of Secondary Postpartum Haemorrhage Research Articles

P-781 Assisted reproductive technology-associated risk factors for retained placenta

Abstract Study question What are the assisted reproductive technology-associated risk factors for retained products of conception (RPOC) following delivery? Summary answer Frozen embryo transfer (FET) with hormone replacement cycles (HRC) constitutes the largest risk factor for RPOC. What is known already RPOC is a key cause of secondary postpartum hemorrhage. Previous studies have shown that the use of ART increases the risk of RPOC and subsequent transfusion following delivery. However, the relationships between specific ART-treatment factors and the risk of RPOC have not been elucidated. Study design, size, duration We performed a registry-based retrospective cohort study using the Japanese national ART registry, in which all the ART cycles performed in Japan are recorded including the perinatal outcomes. Participants/materials, setting, methods Singleton live births between 2007 and 2017 were studied (n = 306,411). Odds ratios (ORs) and 95% confidence intervals (CIs) for the potential risk factors for RPOC associated with fresh and frozen cycles were obtained from multiple logistic regression analysis, incorporating adjustment for maternal age, infertility, and calendar year. Because information regarding assisted hatching (AH) and HRC for endometrial preparation only became available in 2012, these factors were analysed using the data collected between 2012 and 2017. Main results and the role of chance RPOC was diagnosed for 132 deliveries (0.04%), of which 122 (92.4%) followed FET cycles and only 10 (0.01%) followed fresh embryo transfer (ET). No significant risk factors for RPOC were identified using the fresh ET data. For FET cycles, the use of HRC as an endometrial preparation method represented the largest risk factor (adjusted OR, 4.9; 95% CI, 2.0 to 12.3), with RPOC occurring in 0.05% of deliveries following HRC (51/97, 958 deliveries) but in only 0.01% following natural cycles (5/47, 79 deliveries). AH was also associated with a significantly higher risk of RPOC (adjusted OR, 1.9; 95% CI, 1.2 to 3.1), although the risk was lower than that associated with HRC). Subgroup analysis showed that these significant associations of HRC and AH with RPOC were present for transvaginal deliveries, but not deliveries by caesarean section. Limitations, reasons for caution The registry lacks important information regarding risk factors for RPOC, such as parity, body mass index, and history of previous uterine surgery. Furthermore, the lower prevalence of RPOC in the present study (0.04%) than in other studies (approximately 1%) suggests the possibility of non-differential misclassification for the outcomes of RPOC. Wider implications of the findings Although the possibility of residual confounding factors remains, the present findings suggest that additional care should be taken in the management of patients undergoing vaginal deliveries following FET who have HRC or AH. Trial registration number Not applicable

Iatrogenic uterine vascular lesion: A rare cause of secondary postpartum hemorrhage– case report

Iatrogenic uterine vascular lesion: A rare cause of secondary postpartum hemorrhage– case report

Imaging in Uterine Artery Pseudoaneurysm: A Rare, Potentially Fatal Cause of Secondary Post-partum Hemorrhage

Secondary postpartum hemorrhage is one of the important cause of postpartum morbidity and mortality. Uterine artery pseudoaneurysm is a rare, potentially fatal but treatable cause of secondary post-partum hemorrhage. If not diagnosed timely, it can lead to life-threatening hemorrhage. We report the case of a 41-year-old woman who presented with profuse vaginal bleeding on 32nd day of cesarean section. On imaging a left uterine artery pseudoaneurysm was found in the uterine wall with blood clots in the uterine cavity. Patient was managed with aggressive fluid resuscitation and immediate interventional radiology procedure of selective embolization of pseudoaneurysm. High index of suspicion is needed to search for rare vascular causes like pseudoaneurysm.

Secondary postpartum hemorrhage: Incidence, etiologies, and clinical courses in the setting of a high cesarean delivery rate.

To evaluate the incidence, etiologies, and clinical outcomes of secondary postpartum hemorrhage in a hospital with a high cesarean section rate and to compare the etiologies of secondary postpartum hemorrhage following cesarean delivery versus vaginal delivery. This retrospective study included 123 women with secondary postpartum hemorrhage who were treated at a tertiary-level hospital between January 2004 and June 2018. Descriptive statistics and the chi-square test were used for data analysis. The incidence of secondary postpartum hemorrhage was 0.21%. The median onset of bleeding was 12 days after delivery. Fifty-two percent of the deliveries were by cesarean section. The most common etiology of secondary postpartum hemorrhage was endometritis (67.5%), followed by retained placental tissue (21.1%). Women who delivered by cesarean section had a higher rate of endometritis (80.0% vs 53.4%) and a lower rate of retained placental tissue (10.8% vs. 32.8%) than those who delivered vaginally. Surgical intervention included uterine evacuation in 29.3% and hysterectomy in 8.1% of the patients. Five percent of women were treated by embolization. Endometritis was the most common cause of secondary postpartum hemorrhage. Women who delivered by cesarean section were less likely to have retained placental tissue but were at higher risk for endometritis and uterine pseudoaneurysm than those who delivered vaginally.

The RPOC long axis is a simple indicator for predicting the need of invasive strategies for secondary postpartum hemorrhage in either post-abortion or post-partum women: a retrospective case control study

BackgroundThe retained products of conception (RPOC) and related conditions (RPOC-ARC) are the main cause of secondary postpartum hemorrhage (sPPH), but there is no clear consensus for their management. The purpose of this study was to characterize those RPOC-ARC that require invasive treatment and those that could be managed more conservatively.MethodsWe retrospectively analyzed 96 cases of RPOC-ARC that occurred after miscarriage, abortion, or delivery at a gestational age between 12 and 42 completed weeks, that were managed within our institution from May 2015 to August 2020. We reviewed the associations between the occurrence of sPPH requiring invasive treatment with clinical factors such as the maternal background and the characteristics of the lesions.ResultsThe range of gestational age at delivery in our study was 12–21 weeks in 61 cases, 22–36 in 5, and 37 or later in 30. Among them, nine cases required invasive procedures for treatment. The onset of sPPH was within one month of delivery in all but two cases, with a median of 24 days (range 9–47). We found significant differences between requirements for invasive versus non-invasive strategies according to gestational age at delivery, assisted reproductive technology (ART) pregnancy, amount of blood loss at delivery, and the long axis of the RPOC-ARC lesion (p = 0.028, p = 0.009, p = 0.004, and p = 0.002, respectively). Multivariate analysis showed that only the long axis of the lesion showed a significant difference (p = 0.029). The Receiver Operating Characteristic (ROC) curve for predicting the need for invasive strategies using the long axis of the lesion showed that with a cutoff of 4.4 cm, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was 87.5, 90.0, 43.8, and 98.7%, respectively.ConclusionThe long axis of the RPOC-ARC is a simple indicator for predicting which sPPH will require invasive procedures, which use is rare in cases with lesions less than 4.4 cm or those occurring after the first postpartum month. Conservative management should be considered in such cases.

Block the Roads, Lock the Doors

Pseudoaneurysm of the uterine arteries is a rare cause of secondary postpartum haemorrhage (PPH), following caesarean section or vaginal delivery. Whilst uterine artery embolization serves as an important and effective treatment for most cases of symptomatic uterine artery pseudoaneurysm, it is not without the risk of failing. Herein, we report a case of a near missed uterine artery pseudoaneurysm with nidus measuring about 1.7 x 2.7 x 2.8 cm. presenting as secondary postpartum haemorrhage 19 days post lower segment caesarean section, who underwent bilateral uterine arteries embolisation using Polyvinyl Alcohol (PVA) particles and gel foam until near stasis. Immediate check angiogram post uterine artery embolization (UAE) in our case reveals no residual pseudoaneurysm, however our patient had recurrent bleeding 2 days following the procedure. Repeated transabdominal ultrasound following recurrent bleeding showed similar size of colour doppler uptake at uterine fundus which indicates reperfusion of the pseudoaneurysm. Block the roads and lock the doors, the recurrent bleeding was managed successfully with prolonged Bakri Balloon tamponade. This case report was written with the objective of identifying the role of balloon tamponade as a method in the treatment of secondary PPH secondary to uterine arteries pseudoaneurysm. We also aim to show that with colour doppler ultrasounds as a basic imaging equipment in obstetric hospitals, we can spare the repercussion of a missed diagnosis of uterine artery pseudoaneurysm. Bakri Balloon used as uterine tamponade may be a treatment of choice with single lesion pseudoaneurysm which protrudes into the uterine cavity and not involving the lower segment of the uterus. Further studies however are needed to determine the size of pseudoaneurysm suitable for obliteration using prolonged balloon tamponade.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S6

Three-dimensional computed tomography is effective in diagnosing uterine arterial pseudoaneurysm, a cause of secondary postpartum hemorrhage: A case report

Uterine artery pseudoaneurysm is a rare cause of secondary postpartum hemorrhage. Herein, we report a case of uterine artery pseudoaneurysm, with postpartum hemorrhage commencing 22 days after uncomplicated vaginal delivery. Intermittent bleeding occurred during conservative observation. Transvaginal ultrasound color Doppler imaging revealed swollen vascular structures that suggested arteriovenous malformations, and a saccular dilatation of blood vessels. However, it was insufficient to definitively diagnose the condition as pseudoaneurysm. Meanwhile, the three-dimensional computed tomography angiogram was effective in demonstrating a pseudoaneurysm in the uterus, and an absent early venous return sign, leading to the final diagnosis of a pseudoaneurysm. The patient was successfully treated with transarterial embolization using gelatin sponge pledgets. No bleeding or recurrence of the pseudoaneurysm was observed 2 months after embolization.

Bilateral uterine artery embolization for the management of bilateral uterine artery pseudoaneurysm during puerperium: A case report

Background: Uterine artery Pseudoaneurysm is a rare cause of secondary postpartum hemorrhage (PPH) and can develop after various gynecological or obstetric procedures. The delayed diagnosis of such cases often results in life threatening situations. We report a rare case of bilateral uterine artery pseudoaneurysm that led to life threatening secondary PPH after Caesarean section in a patient who had several Caesarean sections before. Case description: A 35 years old multiparus women, who had all her four deliveries by Caesarean sections, presented with recurrent massive attacks of secondary PPH 35ays after her last delivery. Rupture of aneurysm of the uterine artery was suspected and CT angiography showed that the left uterine artery seemed more dilated and was probably the source of the PPH. The bleeding site was successfully tackled by selective arterial embolization. About three weeks later the patient presented again with severe recurrence of PPH. Repeat of CT angiography showed that the source was the right uterine artery this time, which was again selectively embolized. No further bleeding events occurred up to two years follow-up. Conclusion: Rupture of aneurysm of the uterine artery can be a life-threatening condition. Clinical suspicion is essential for a prompt diagnosis Definitive diagnosis can be achieved by CT-angiography. Treatment by selective embolization can effectively stop the bleeding.

Predictive factors for secondary postpartum hemorrhage: a case-control study in Japan

Background Secondary postpartum hemorrhage (PPH) is defined as excessive vaginal blood loss occurring between 24 h and 6–12 weeks after birth. The incidence of secondary PPH varies from 0.2% to 3.0%, and the peak incidence ranges from 1 to 2 weeks postpartum. There is no clinical evidence regarding the cause of secondary PPH. Therefore, this study aimed to determine the predictive factors for secondary PPH in an Asian population. Methods A case-control study was performed. The clinical data of 25 secondary PPH patients who had been admitted to our hospital between June 2012 and January 2019 were obtained for this study. Control patients (n = 100) were selected from pregnant women who delivered at the hospital during the same period; they were matched to secondary PPH patients using propensity score matching to adjust for maternal age at delivery, parity, and the use of assisted reproductive technology (ART). A multiple logistic regression analysis was used to determine the predictive factors for secondary PPH. Results The median maternal age was 34 years (range, 24–42 years); 85 (68.0%) women were nulliparous, 31 (24.8%) used ART, and 116 (92.8%) had term deliveries. Immediate PPH (adjusted odds ratio [OR], 2.84; 95% confidence interval [CI], 1.04–7.75) and manual removal of the placenta (adjusted OR, 6.14; 95% CI, 1.21–31.1) were associated with secondary PPH. Conclusion Increasing the awareness of the predictive factors for secondary PPH could play an important role in the recognition and treatment of postpartum morbidity.

Secondary Postpartum Haemorrhage following vaginal delivery - a 3-year survey of causes and management.

Secondary postpartum haemorrhage (PPH) is a serious complication of childbirth and a life-threatening condition that may lead to infertility amongst women during the reproductive age groups. The objective of this study is to highlight the underlying causes of secondary PPH and outcomes for patients who delivered vaginally, with the aim of reducing maternal mortality and morbidity. This is a prospective cohort study conducted in the Department of Obstetrics and Gynaecology at AL-Yarmouk Teaching Hospital, Baghdad, Iraq. The study was conducted over a 3-year period from December 2015 to December 2018. Women who delivered vaginally with a gestational age of at least 24 weeks, with no previous caesarean or uterine scars, who were admitted to the hospital complaining of bleeding from their genital tracts after 24 hours of delivery, but prior to 6 weeks from delivery, were enrolled in the study. Patients received resuscitative measures and medical treatment and were observed regarding their response to medical treatment and whether they required surgical intervention. Types of management were also evaluated, and histopathological reviews were gathered and recorded for those who needed retained pieces of product evacuated or hysterectomies. Two hundred cases were analysed; the incidence of severe secondary postpartum haemorrhage was 60 per 10,000 deliveries. Endometritis was the leading cause (64% of patients), followed by retained placental pieces (13.5%); emergency hysterectomy was performed in 34.5% of patients. This study is novel because it is the first to shed light on secondary postpartum haemorrhage in unscarred uteri in Iraq. Endometritis was the most common cause of secondary postpartum haemorrhage, and emergency hysterectomy was the most common strategy of treatment.

Risk Factors and Maternal Outcome of Secondary Post Partum Haemorrhage in Rangpur Medical College Hospital. - A one year study

Background: Post partum haemorrhage (PPH) is one of the most common causes ofmaternal mortality worldwide. Primary PPH (which occurs within 24 hours of delivery) hasbeen studied a lot. But data regarding secondary PPH (which occurs 24 hours after deliveryupto to 6 weeks post partum) is sparse. Our aim was to find out the risk factors and maternaloutcome of secondary PPH.
 Materials and Methods: A cross sectional analytic study of 32 cases admitted with secondaryPPH in Gynae and Obstetric department of Rangpur Medical College Hospital during 1 yearstudy period was carried out.
 Result: Frequency of secondary PPH was 0.58%. Mean age of the patient was 25.23±2.79years; 22(69%) patients were multi para; 17 (53%) patients had education up to primarylevel. Maximum patients [18 (56%)] were from low socio economic status. Mean time ofpresentation was 13.5±2.78 days after delivery; 14(44%) patients delivered vaginally and18(56%) patients delivered by caesarean section. Most of the vaginal delivery 9 (28%) wereconducted by untrained dai or other family member. Among 32 patients, 31 were referredfrom outside the Hospital. Retained bits of placenta was the leading cause (15,47%) andcaesarean wound dehiscence was the second cause (13,41%); 13 (40%) patients had feveron presentation. All were anemic with mean hemoglobin concentration 7.4±1.4gm and 24(75%) of them required blood transfusion. Four patients was in shock. Antibiotic was givento all patients. DE&C was done in 15(47%) cases and laparotomy followed by total abdominalhysterectomy was done in 12 cases and repair in 1 case. Among 15 patients who underwentsurgical evacuation there was histological evidence of placental tissue in only 6(40%) patients.
 Conclusion: In present study retained bits of placenta and caesarean wound dehiscenceare found as main cause of secondary postpartum hemorrhage So care should be takenduring active management of third stage of labour (AMTSL). Choosing appropriate suturematerial, maintaining personal hygine of patient and sterility of operation theate, usingappropriate antibiotic to combat microbials and last but not list improving skillness of surgeonare the key to reduce the rate of secondary PPH.
 Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 107-112

Μassive secondary postpartum hemorrhage caused by pseudoaneurysm of uterine artery, treated with uterine artery embolization – An uncommon case report

Introduction: Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage that can be fatal. Material & Methods: We present a case of a 42-year-old woman who developed massive secondary postpartum hemorrhage 17 days after c-section and was diagnosed to have pseudoaneurysm from the left uterine artery on computed tomography scan. After blood transfusion she got hemodynamically stable and selective transcatheter arterial embolization was performed. Results: The pseudoaneurysm was successfully obliterated. Conclusions: Angiographic embolization is a safe and competent method for managing postpartum hemorrhage caused by pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the preferred method for hemodynamically unstable patients when fertility preservation is strongly desired. In a woman with unexplained vaginal bleeding after c-section , pseudoaneurysm should be considered in the differential diagnosis of secondary postpartum hemorrhage. Angiographic embolization should be examined as a treatment method before turning to surgery, in suitable selected cases.

Uterine Arteriovenous Malformation as a Cause of Secondary Postpartum Hemorrhage: A Case Report

ABSTRACT Background Uterine arteriovenous malformation (AVM) is a very rare cause of secondary postpartum hemorrhage (PPH) which might present along with retained products of conception (RPOC). Despite being a rare entity, it is a life-threatening condition and hence high degree of suspicion is required for prompt diagnosis and appropriate treatment as certain procedures, such as instrumental evacuation, commonly performed for RPOC could be devastating. With the recent advancements, color Doppler ultrasonography has become a preferred noninvasive method for diagnosing AVM though angiography remains the gold standard for diagnosis. Case description This case report describes a 36-year-old multiparous woman who presented 3 weeks after delivery by lower segment cesarean section (LSCS) with secondary PPH. Transabdominal ultrasound (TAS) revealed an involuting uterus with an ill-defined hypoechoic area within the myometrium adjacent to the endometrium with significant intrinsic vascularity raising the suspicion of placenta accreta. Magnetic resonance imaging (MRI) with contrast was performed for confirmation which showed an AVM with coexistent RPOC. Since the patient did not give consent for uterine artery embolization which was offered to her during counseling, hysterectomy was carried out. Histopathological diagnosis of uterine AVM was conclusive. Conclusion Arteriovenous malformation, although a rare entity, should be ruled out in a patient presenting with hemorrhage after delivery/miscarriage even if the imaging shows the presence of RPOC by the diagnostic modalities available so that appropriate treatment can be instituted. How to cite this article Sambashivaiah J, Velayudam L, Tigga M, et al. Uterine Arteriovenous Malformation as a Cause of Secondary Postpartum Hemorrhage: A Case Report. J South Asian Feder Obst Gynae 2020;12(3):188–191.

YOUR GUESS IS AS GOOD AS MINE; DEALING WITH RECURRENT SECONDARY POST-PARTUM HAEMORRHAGE CAUSED BY UTERINE ARTERY PSEUDOANEURYSM

Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum haemorrhage (PPH). Ultrasound may suggest this condition and pelvic arteriography is done to confirm the diagnosis and to institute treatment via uterine artery embolization. Herein, we describe a case who experienced recurrent episodes of secondary PPH with inconclusive findings on ultrasound and pelvic arteriography. Foley catheter balloon was used several times to arrest acute bleeding episodes. Exploratory laparotomy revealed pseudoaneurysm of the branch of right uterine artery. Transection and ligation of the involved artery followed by ligation of bilateral internal iliac arteries were performed. Post operation, patient made a full recovery. This case highlights uterine artery pseudoaneurysm as a rare but important cause for secondary PPH. We recommend a simple measure to provide intrauterine tamponade by using Foley catheter balloon. Diagnosis of UAP may not be straightforward and this condition may only be discovered during surgery.

Secondary Postpartum Haemorrhage: Causes and Management In A Tertiary Care Hospital

Objective: To find out the frequency of secondary postpartum haemorrhage (pph) as well as its causes and management in women presenting in a tertiary care hospital
 Methods: It was a descriptive case series study conducted from 1st January 2016 to 31st December 2016 at the Department of Gynaecology and Obstetrics, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. All the patients presenting with secondary postpartum haemorrhage in the specified time period were included in the study. The patient's age, parity, booking status, mode of delivery, place of delivery, cause of secondary postpartum haemorrhage and management done was noted on a predesigned proforma.
 Results: The average age of the women was 30.62 ± 4.37 years. Postpartum haemorrhage was ob- served in 130 patients, out of these 27 patients had secondary postpartum haemorrhage with a fre- quency of 20.67%. Majority of the women with secondary pph were multiparous 17 (62.96%) with 21 (77.77%) being delivered vaginally compared to 6 (22.22%) who had caesarean section. Most of the women 16 (59.25%) presented with secondary pph around 10-14 days post-delivery. Retained placen- tal pieces was identified as the commonest cause in 19 (70.37%) women, antibiotics was given to all the patients, evacuation done in 19 (70.37%) cases, 2 (7.40%) women had obstetrical hysterectomy and 1 (3.70%) woman had repair of uterus while 5 (18.51%) cases were managed conservatively. No maternal death was recorded.
 Conclusion: Secondary postpartum haemorrhage though less common but is found to be associated with significant maternal morbidity which require timely diagnosis and management so as to prevent life threatening complications.

Emerging trend in the etiology of postpartum hemorrhage in a low resource setting

Background: While rates of postpartum hemorrhage (PPH) have continued to rise, it is not clear if the etiology and patterns have changed over time. Anecdotal reports have shown that, other than uterine atony, genital tract laceration is emerging as the chief causes of PPH. Objectives: This was to determine the changing trend in the prevalence, causes and maternal mortality associated with PPH in a low resource setting. Methods: A retrospective cohort study of all parturients that had PPH at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from January 1st, 2006 to December 31st, 2015 was conducted. Post-partum blood loss was calculated by estimating blood losses in graduated containers and in bed lines and gauze packs. Results: During the period under review, a total of 10,502 deliveries were conducted, out of which 119 women were managed for PPH, giving a prevalence of 1.13%. Sixty-nine (58.0%) had primary PPH and 50 (42.0%) had secondary PPH. The overall leading cause of PPH was retained product of conception in 51 (42.9%). The commonest cause of primary PPH was genital tract laceration in 24 (34.8%) followed by uterine atony in 21 (30.4%). The leading cause of secondary PPH was retained products of conception in 37 (74.0%) cases, whereas its least causes were uterine sub-involution and gestational trophoblastic diseases in 1(2.0%) patient each. There was a significant association between the types of PPH and their risk factors/causes (genital tract laceration, uterine atony, retained product of conception, endometritis and coagulopathy; p<0.05 for all). The majority of the cases of primary PPH (94.6%) survived the condition and 5.4% died. Conclusion: Genital tract laceration has emerged as commonest cause of primary PPH followed by uterine atony, while the leading cause of secondary PPH was retained products of conception. This new trend in etiology warrants further investigation in other regions.

Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions.

Secondary postpartum hemorrhage (PPH) and postabortion hemorrhage are rare complications. Retained products of conception (RPOC) is among the most common causes of both secondary PPH and postabortion hemorrhage. Other less common causes of secondary PPH are uterine vascular abnormalities such as arteriovenous malformations and pseudoaneurysms. These are usually related to a history of a procedure such as dilation and curettage or cesarean delivery. Subinvolution of the placental site is an idiopathic cause of secondary PPH; this condition may be underrecognized and therefore could have a higher incidence than currently reported. Gestational trophoblastic disease is rare but commonly presents as secondary PPH and resembles RPOC in radiologic appearance. The first-line imaging modality for secondary PPH is ultrasound, but computed tomography and magnetic resonance imaging may be used if the ultrasound findings are indeterminate. Angiography is an important tool for the definitive diagnosis of uterine vascular abnormalities. Appropriate management requires radiologists to be familiar with the multimodality imaging features of secondary PPH or postabortion hemorrhage.

Selective Uterine Artery Embolization: An Effective Treatment Option for Postpartum Hemorrhage due to Pseudoaneurysm of Uterine Artery

ABSTRACT Aim To demonstrate the efficacy of uterine artery embolization in the management of postpartum hemorrhage (PPH) due to pseudoaneurysm of the uterine artery. Background Postpartum hemorrhage is a leading cause of maternal mortality in India. Secondary PPH is a rare cause but potentially life threatening. Common causes of secondary PPH are retained products of conception, subinvolution of uterus, and endometritis. Pseudoaneurysm is an uncommon cause of secondary PPH following operative delivery. Color Doppler ultrasound is a useful diagnostic tool and angiography is necessary to localize and treat by embolization. Case report We report two cases of secondary PPH due to pseudoaneurysm of uterine artery, which were managed by selective embolization of uterine artery. Conclusion Angiographic embolization of uterine artery is a safe and reliable technique for management of secondary PPH due to pseudoaneurysm. If diagnosed early, the need for hysterectomy is prevented. Clinical significance Uterine artery embolization has emerged as a simple, effective, and fertility-sparing treatment for PPH. How to cite this article Gollapudi R, Rammurty S. Selective Uterine Artery Embolization: An Effective Treatment Option for Postpartum Hemorrhage due to Pseudoaneurysm of Uterine Artery. J South Asian Feder Obst Gynae 2017;9(3):283-286.

Uterine Arteriovenous Malformation: A Rare Cause of Secondary Postpartum Hemorrhage

Ruptured uterine arteriovenous malformation (AVM) such as uterine artery pseudoaneurysm is an extremely rare cause of secondary postpartum hemorrhage (PPH), thus causing a diagnostic and therapeutic dilemma for the managing obstetricians. We describe a case of a 40-year-old lady who presented with recurrent intractable secondary PPH unresponsive to conventional treatment following an emergency lower segment cesarean section (LSCS). This was her second LSCS for a failed trial of vaginal birth after cesarean section (VBAC). Subsequently left uterine artery extravasation was identified on pelvic angiogram and selective embolization was done with successful treatment of her PPH. To date, there have been only case reports or case series available on literature due to its rarity of the diagnosis. We wish to raise awareness of this rare diagnosis in patients with risk factors as a cause of recurrent PPH not responding to medical management. We also wish to share our experience with the successful use of selective uterine artery embolization for the management of this condition which resulted in avoidance of hysterectomy and its associated morbidity. J Med Cases. 2017;8(5):152-154 doi: https://doi.org/10.14740/jmc2804w

Uterine Arteriovenous Malformation: A Rare Cause of Secondary Postpartum Hemorrhage

Ruptured uterine arteriovenous malformation (AVM) such as uterine artery pseudoaneurysm is an extremely rare cause of secondary postpartum hemorrhage (PPH), thus causing a diagnostic and therapeutic dilemma for the managing obstetricians. We describe a case of a 40-year-old lady who presented with recurrent intractable secondary PPH unresponsive to conventional treatment following an emergency lower segment cesarean section (LSCS). This was her second LSCS for a failed trial of vaginal birth after cesarean section (VBAC). Subsequently left uterine artery extravasation was identified on pelvic angiogram and selective embolization was done with successful treatment of her PPH. To date, there have been only case reports or case series available on literature due to its rarity of the diagnosis. We wish to raise awareness of this rare diagnosis in patients with risk factors as a cause of recurrent PPH not responding to medical management. We also wish to share our experience with the successful use of selective uterine artery embolization for the management of this condition which resulted in avoidance of hysterectomy and its associated morbidity. J Med Cases. 2017;8(5):152-154 doi: https://doi.org/10.14740/jmc2804w