Rupture of a pseudoaneurysm as a rare cause of severe postpartum hemorrhage: analysis of 11 cases and a review of the literature

Objective

To clarify the clinical features of severe postpartum hemorrhage (PPH) resulting from a ruptured pseudoaneurysm and to determine the efficacy of selective arterial embolization as a method of management.

Study design

Eleven women who underwent selective arterial embolization for treatment of severe hemorrhage due to a ruptured pseudoaneurysm were identified from 2 hospitals within the past 5 years. A retrospective analysis was performed to identify the clinical characteristics of the hemorrhage and to evaluate the efficacy of arterial embolization.

Results

Nine women delivered by cesarean delivery. Eight of the 11 women had late PPH with onset of bleeding occurring 6–100 days (median, 11.5) after delivery. The average volume of transfusion was 3196 ml of packed red blood cells (range, 1600–8980 ml). Uterine atony occurred in only one patient and was accompanied by an intrauterine abscess. Administration of uterotonic agents did not diminish the bleeding. Only one patient out of 11 underwent re-embolization.

Conclusion

If late PPH without uterine infection or retained placenta occurs after cesarean delivery, one should suspect the possibility of a ruptured pseudoaneurysm. Selective arterial embolization may be considered as a primary means of treatment.