Rupture of the uterine artery pseudoaneurysm causing late postpartum hemorrhage: case report and literature review

INTRODUCTION: Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide. A rare but potentially life-threatening cause of secondary PPH is uterine artery pseudoaneurysm (UAP). In this case report, we present two clinical cases of UAP and review the available literature summarizing clinical symptoms, diagnostic approaches and treatment options. CASE PRESENTATION: The first case involved a patient presenting with abdominal pain and syncope six days after vaginal delivery, subsequently diagnosed with a right-sided UAP and hemoperitoneum. The second patient presented with painless yet heavy vaginal bleeding and was also diagnosed with a right-sided UAP. Both patients were successfully managed with uterine artery embolization. CONCLUSIONS: UAP may present atypically, either with or without vaginal bleeding. Possible reported risk factors include cesarean delivery, uterine curettage, endometriosis, inflammation, cervical conization, myomectomy, and excision of cesarean scars. Transvaginal sonography (TVS) is the first-line diagnostic tool due to its accessibility, while computed tomography (CT) or magnetic resonance imaging (MRI) are helpful for confirmation and treatment planning. Endovascular embolization is the treatment of choice in hemodynamically stable patients due to its minimally invasive nature and favorable outcomes.