Uterine artery pseudoaneurysm: Rare cause of delayed postpartum hemorrhage

To identify a rare but potentially life-threatening cause of delayed postpartum hemorrhage.

A 36-year-old woman, gravida 1, para 1, had just underwent cesarean section at a local clinic and the immediate postpartum recovery was well. At two months postpartum, following strenuous exercise, two sudden episodes of massive vaginal bleeding occurred, accompanied by tachycardia, blood pressure drop to 81/50 mmHg and anemia of 8.7 g/dl in hemoglobin. Transvaginal ultrasonography and computed tomography revealed a 1.6 cm pulsating mass near the left uterine artery. After shared decision-making and fertility counseling following another episode of bleeding, transcatheter arterial embolization was performed, where the left uterine artery pseudoaneurysm was successfully identified and occluded using a combination of Gelfoam and coil. She was discharged on post-procedure day 2.

Care providers must keep in mind the diagnosis of pseudoaneurysm in the postpartum stage when a pulsating mass is detected in the uterus.