Yi Sang Wook
a Department of Obstetrics and Gynecology , Gangneung Asan Hospital, University of Ulsan College of Medicine , Gangneung , Korea.
J Obstet Gynaecol. 2017 May;37(4):416-420. doi: 10.1080/01443615.2016.1274292. Epub 2017 Feb 25.
Postpartum haemorrhage (PPH) remains one of the leading causes of maternal death worldwide and can be classified as either immediate (primary) or delayed (secondary) according to the onset time - before or after 24 hours postpartum. Uterine pseudoaneurysm is a rare cause of PPH that has been suggested to arise from abnormal vascular regression and a recurrent vascular healing state, such as a vascular stricture and relaxation with thrombin deposits after placental expulsion. With advances in multidetector computed tomography, 3D-computed tomography with angiography can aid in identifying the location and originating vessels of the pseudoaneurysm via fast and clear 3D images. Once a bleeding pseudoaneurysm is diagnosed as the cause of PPH, conservative management is frequently unsuccessful in controlling bleeding. Transcatheter uterine arterial embolisation appears to be the treatment of choice in haemodynamically stable women.
产后出血(PPH)仍然是全球孕产妇死亡的主要原因之一,根据发病时间可分为即时性(原发性)或延迟性(继发性)——产后24小时之前或之后发病。子宫假性动脉瘤是产后出血的一种罕见原因,据认为它源于异常的血管退化和反复出现的血管愈合状态,例如胎盘排出后出现血管狭窄和松弛并伴有凝血酶沉积。随着多排螺旋计算机断层扫描技术的进步,三维计算机断层扫描血管造影术能够通过快速、清晰的三维图像帮助识别假性动脉瘤的位置和起源血管。一旦诊断出血性假性动脉瘤是产后出血的病因,保守治疗往往无法成功控制出血情况。对于血流动力学稳定的女性,经导管子宫动脉栓塞术似乎是首选的治疗方法。