Hysteroscopic Diagnosis of Uterine Artery Pseudo-Aneurysm in a Case of Secondary Postpartum Hemorrhage

Aim: Aim is to raise the value of hysteroscopy in diagnosing uterine artery pseudo-aneurysm in patients with secondary postpartum hemorrhage.

Presentation of Case: Here we report a case of 34 year-old woman presented to the emergency department with recurrent attacks of secondary postpartum hemorrhage after cesarean delivery. Diagnostic hysteroscopy was done after controlling of the bleeding and confirmed a large cesarean scar defect with a large pulsating vessel in its left side wall that was diagnosed later by angiography as left uterine artery pseudo-aneurysm. Despite trans-catheter arterial embolization of both uterine arteries, the patient developed severe attack of bleeding with hypovolemic shock necessitating emergency hysterectomy.

Discussion: Uterine artery pseudo-aneurysm is a rare cause of secondary postpartum hemorrhage that should be suspected in cases of recurrent bleeding after caesarean section with the absence of remnants of conception.

Uterine artery pseudo-aneurysm diagnosed by color Doppler sonography and computed tomography (CT), magnetic resonance imaging and angiography. Diagnostic hysteroscopy is a minimally invasive procedure that should be used to diagnose uterine artery pseudo-aneurysm in suspected cases after controlling of the bleeding.

Conclusion: Hysteroscopy should be used to exclude uterine artery pseudo-aneurysm before any attempt to do uterine curettage in patients with secondary postpartum hemorrhage after cesarean section, where the aneurysm might be injured accidently during the procedure resulting in uncontrollable hemorrhage.