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Korean Journal of Obstetrics & Gynecology 2004;47(11):2236-2240.
Published online November 1, 2004.
An uncommon cause of postpartum hemorrhage after cesarean section treated with selective arterial embolization: Pseudoaneurysm of the uterine pedicle.
Min Joung Kim, Chul Hoon Park, In Kwen, Hee Joung Lee, Soo Young Hur, Eun Joung Kim, Gui SeRa Lee, Hae Gue Lee, Sa Jin Kim
1Department of Obstetrics and Gynecology, College of Medicine, Catholic University of Korea.
2Department of Radiology, College of Medicine, Catholic University of Korea.
This is a very important differential diagnosis for postpartum hemorrhage following cesarean delivery because repeated life-threatening bleeding may induce multiple blood transfusion and require emergency surgery including hysterotomy. False or pseudoanuerysm can be acquired in association with trauma, previous surgery, trophoblastic disease, neoplasm, infection or diethylstilbestrol exposure. When a punctured or lacerated artery does not seal completely, blood may escape and dissects the adjacent tissues, and collects in perivascular areas. If this collection maintains in communication with the parent vessel, a pseudoaneurysm could result. Typically the lesion are discovered because the patients have symptoms related to delayed rupture of the pseudoaneurysms, causing hemorrhage. Radiographic techniques (angiography, ultrasound, and magnetic resonance imaging) have provided the opportunity to diagnose pseudoaneurysm, arteriovenous malformation. We report a case of postpartum hemorrhage following cesarean delivery attributed to a pseudoaneurysm of the uterine pedicle and treated with arterial embolization. Angiographic study confirmed the diagnosis and embolization of the false aneurysm was successful in controlling the hemorrhage.
Key Words: Cesarean section, Postpartum hemorrhage, Pseudoanuerysm, Arterial embolization

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