Bilateral iliac artery aneurysm: A rare cause of postpartum recurrent hemorrhage

Postpartum hemorrhage (PPH) is a critical health problem that may result in maternal death. In cases of impaired maternal hemodynamics, several surgical therapies such as hypogastric artery ligation or postpartum hysterectomy may be employed to control the bleeding. A 30-year-old multiparous patient who had given birth via spontaneous vaginal delivery had undergone hysterectomy and then hypogastric artery ligation due to postpartum hemorrhage. The patient was referred to our clinic due to uncontrolled bleeding and she experienced recurrent episodes of massive hemorrhage during her follow-up in our clinic. Pelvic angiography performed by interventional radiologists to detect the bleeding focus revealed arteriovenous fistula and aneurysm in the right internal iliac artery and incomplete ligation of the left internal iliac artery. The bleeding was controlled by selective embolization through coiling of the fistula in the right internal iliac artery and branches of the left uterine artery. PPH is still an important cause of maternal mortality and vascular structural anomalies must be borne in mind in cases with delayed onset.