Wu Clara Q, Nayeemuddin Mohammed, Rattray Darrien
Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada.
Department of Radiology, Regina General Hospital, Regina, Saskatchewan, Canada.
BMJ Case Rep. 2018 Jul 11;2018:bcr-2018-224656. doi: 10.1136/bcr-2018-224656.
Uterine artery pseudoaneurysm (UAP) is a rare cause of delayed postpartum haemorrhage. Early diagnosis and endovascular management are effective in treating this condition. We present the case of a 36-year-old gravida 3, para 2 woman with delayed postpartum haemorrhage and endometritis following a spontaneous vaginal delivery. Ultrasound and catheter angiogram demonstrated a UAP arising from the distal aspect of the left uterine artery. Significant bleed persisted despite selective bilateral uterine artery embolisation. A repeat angiogram confirmed complete occlusion of bilateral uterine arteries, but abdominal aortogram demonstrated that the left ovarian artery was now feeding the pseudoaneurysm. A repeat embolisation procedure was performed to occlude the left ovarian artery. The patient was discharged the following day. Selective arterial embolisation is effective in the management of UAP. Persistent bleeding despite embolisation should raise the suspicion of anastomotic vascular supply and may require repeat embolisation.
子宫动脉假性动脉瘤（UAP）是产后延迟出血的罕见原因。早期诊断和血管内治疗对该病有效。我们报告一例36岁、孕3产2的妇女，在自然阴道分娩后出现产后延迟出血和子宫内膜炎。超声和导管血管造影显示左子宫动脉远端出现一个UAP。尽管进行了选择性双侧子宫动脉栓塞，但仍有大量出血。重复血管造影证实双侧子宫动脉完全闭塞，但腹主动脉造影显示左卵巢动脉现正向假性动脉瘤供血。进行了重复栓塞手术以闭塞左卵巢动脉。患者次日出院。选择性动脉栓塞对UAP的治疗有效。栓塞后仍持续出血应怀疑存在吻合血管供血，可能需要重复栓塞。
