Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.
Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.