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Concealed postpartum hemorrhage treated with transcatheter arterial embolization
Leslie K Po1, Martin E Simons, Elyse S Levinsky
1From the Department of Obstetrics and Gynaecology, Mount Sinai Hospital, the University of Toronto, and the Departments of Vascular and Interventional Radiology, University Health Network and Mount Sinai Hospitals, Toronto, Canada.
Obstetrics and Gynecology
|July 25, 2012
Summary
Postpartum hemorrhage, a serious obstetric emergency, can rarely be caused by arteriovenous fistulas. Transcatheter arterial embolization effectively treated a case of vaginal arteriovenous fistula causing concealed postpartum hemorrhage.
Area of Science:
- Obstetrics and Gynecology
- Vascular Surgery
- Interventional Radiology
Background:
- Postpartum hemorrhage (PPH) is a leading cause of maternal mortality.
- Concealed PPH presents diagnostic challenges.
- Arteriovenous fistulas are a rare etiology of PPH.
Observation:
- A 20-year-old woman developed hemodynamic instability 12 hours postpartum.
- A large vaginal hematoma was identified.
- Angiography revealed a traumatic arteriovenous fistula of the right pudendal artery.
Findings:
- Transcatheter arterial embolization successfully occluded the arteriovenous fistula.
- The patient had an uneventful post-procedure recovery.
Implications:
- Vaginal arteriovenous fistulas must be considered in concealed PPH.
- Transcatheter arterial embolization is a viable and effective treatment for this condition.
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