Trans-Arterial Embolization On A Catastrophic Primary Postpartum Hemorrhage Due To Arterial Aneurysm With Arteriovenous Fistula At Bilateral Lower Vagina: A Case Report

Trans-Arterial Embolization On A Catastrophic Primary Postpartum Hemorrhage Due To Arterial Aneurysm With Arteriovenous Fistula At Bilateral Lower Vagina: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Case report Trans-Arterial Embolization On A Catastrophic Primary Postpartum Hemorrhage Due To Arterial Aneurysm With Arteriovenous Fistula At Bilateral Lower Vagina: A Case Report Cheng-Hsien Wu, Yon-Cheong Wong, Patricia Wanping Wu, Ho-Yen Chueh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-714094/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Failure of the primary management at controlling the post-partum hemorrhage (PPH) is occasionally encountered. A catastrophic cause of PPH as vagina arterial aneurysms with AVF is rare and not reported in English literature. Case presentations: We present a 34-year-old woman of arterial aneurysms with arteriovenous fistulas (AVF) at bilateral lower vagina causing intractable PPH with aggressive bleeding. By trans-arterial embolization (TAE) the bleeding is successfully controlled, and patient then could recover smoothly. Conclusion: These vascular anomalies being fierce culprit of the PPH would result in primary management failure. Knowledge of the possible etiology of post-partum hemorrhage is crucial for treatment management. This case report aims to point out a pivotal role of TAE at detecting and treating this unusual cause of PPH. Internal Medicine Post-partum hemorrhage (PPH) arterial aneurysm arteriovenous fistula (AVF) Trans-arterial embolization (TAE) Figures Figure 1 Figure 2 Figure 3 Introduction Postpartum hemorrhage is a major cause of maternal morbidity and mortality, worldwide( 1 ). PPH is often clinically assessed by the care givers, particularly at the emergent situation( 2 ). The usual etiologies of PPH include genital tract laceration, uterus atony, uterine rupture, placenta retention, coagulopathy( 3 – 5 ). Of these, the vascular injury and anomalies such as aneurysm, arteriovenous fistula (AVF) and arteriovenous malformation (AVM) are fierce culprits( 6 ), and vagina arterial aneurysms with AVF in this presented case is rarely seen. Trans-arterial embolization (TAE) is an effective and minimally invasive procedure in managing the PPH( 3 , 4 ). Here, we present a case of lower vaginal arterial aneurysm with AVF causing aggressive PPH successfully controlled by TAE after failure of the primary management. Case Report A 34-year-old woman with obstetric history of G3P0AA2 was 38 + weeks pregnant and otherwise healthy. She was admitted for vaginal delivery after spontaneous rupture of the amniotic membranes. Primary post-partum hemorrhage (PPH) occurred after delivery; initial medical management was ineffective. After blood transfusion and vaginal packing with surgical pads, she returned to normotensive status temporarily. As vaginal bleeding persisted, angiography was performed by which arterial aneurysms with AVFs (Fig. 1) fed by the internal pudendal arteries (Fig. 2) were discovered at the bilateral lower vagina. Hemostasis was achieved by TAE of the aneurysms with metallic coils at each of the distal internal pudendal artery. After 5 days of hospitalization, she recovered well, and a rechecked angiography 3 months later revealed obliteration of the vascular lesions (Fig. 3). Discussion The usual etiologies of PPH include genital tract laceration, uterus atony, uterine rupture, placenta retention, coagulopathy( 3 – 5 ). Vascular injury or anomalies such as aneurysm, AVF and AVM are fierce culprits( 6 ), and vaginal arterial aneurysm with AVF in this presented case is rarely seen. The clinical diagnosis of our presented case is pregnancy-related arterial aneurysms with AVFs at the lower vagina which contributes to the intractable primary PPH. Vaginal arterial aneurysm with AVF as a cause of PPH was not previously reported in English literature, and would render primary treatment methods ineffective. The diagnosis was made by angiographic picture of arterial aneurysms with early draining veins in the lower vagina. Anatomically, there are some arteries that supply the vagina; the anterior and lateral surfaces of the vagina are fed by the vaginal artery; the middle portion by the inferior vesicular artery; the lower part by the internal pudendal artery; and the posterior surface by the middle rectal artery( 4 ). The routine primary management for PPH includes resuscitation, blood transfusion, uterus controlling such as administration of uterotonic drugs, uterine compression, and intrauterine balloon tamponade. If the primary management fails, an intervention of TAE or surgical management should be initiated without any delay( 6 ). The TAE was reported to be effective with a high success rate and was recommended to be first-line therapy to control PPH( 3 ). The most commonly used embolic material in TAE for PPH was gelatin sponge, and bail-out material could be metallic coils or N-butyl cyanoacrylate( 4 ). At this uncommon condition of vaginal arterial aneurysms with AVFs causing PPH, small particle and liquid embolic material should be meticulously used in TAE, as they may increase the risk of IVC and pulmonary embolism owing to embolic material migration through the arterio-venous shunting. Conclusion Vascular anomaly of arterial aneurysms with AVFs at the bilateral lower vagina as a cause of PPH is rare and would make primary treatment unsuccessful. The obstetrician should be aware of the unusual lesions. TAE is especially important in detecting and treating this uncommon culprit. Declarations Ethical Approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. Informed Consent for the percutaneous transarterial embolization was obtained from the patient. This case report has obtained IRB approval from “Chang Gung Medical Foundation Institutional Review Board” and the need for informed consent was waived Consent for Publication: Consent for publication was obtained for every individual person’s data included in the study Availability of data and materials: Not applicable. It is a routine procedure encountered in our daily practice. Competing Interest: The authors have no competing interest to be declared Funding: This study was not supported by any funding. Authors' contributions: The authors have made substantive and specific intellectual contributions to this article and assume full responsibility for its content. Case reviewing by: Cheng-Hsien Wu, Yon-Cheong Wong, Patricia Wanping Wu, Ho-Yen, Chueh. Journal research and reviewing by Cheng-Hsien Wu, Yon-Cheong Wong. Draft writing by Cheng-Hsien Wu, Patricia Wanping Wu. Clinical data collection and certification by Ho-Yen, Chueh. Acknowledgements: We want to thank the work of our radiological colleagues and all the staff at Chang Guang Memorial Hospital involved in the management of the case. Authors' information (optional): as above mentioned References Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Interv Radiol. 2010;33(5):887–95. Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, et al. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG: an international journal of obstetrics gynaecology. 2010;117(10):1278–87. Fu CJ, Irama W, Wong YC, Tseng HJ, Wang LJ, Yeow KM, et al. Transarterial embolization for postpartum hemorrhage: lessons learned. Acta radiologica (Stockholm, Sweden: 1987). 2018;59(12):1451-7. Chen C, Lee SM, Kim JW, Shin JH. Recent Update of Embolization of Postpartum Hemorrhage. Korean J Radiol. 2018;19(4):585–96. Tanahashi Y, Goshima S, Kondo H, Ando T, Noda Y, Kawada H, et al. Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate. Cardiovasc Interv Radiol. 2017;40(2):236–44. Kim JE, So YH, Kim BJ, Kim SM, Choi YH, Sung CK. Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization. Acta radiologica (Stockholm, Sweden: 1987). 2018;59(8):932-8. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 13 Jul, 2021 Submission checks completed at journal 12 Jul, 2021 Editor invited by journal 12 Jul, 2021 First submitted to journal 08 Jul, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-714094","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case report","associatedPublications":[],"authors":[{"id":41391522,"identity":"4b0765d0-30cf-4e25-807a-bbb4f85a75fb","order_by":0,"name":"Cheng-Hsien Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYDACCSBmbGDgAZLtPz5UAHnMzA3EamFukJxxBqSFkTgtQMDeIM3bxgDn4gT8s5uPPfy6o06GX7qxwXDmvNpo/naglh8V23BbcudYurHsmcM8knMONiR83HY8d8ZhxgbGnjO3cWoxkMgxk5ZsO8BjcCOx4eDMbcdyG4BamBnb8GnJ/wbUUsdjfyOxsZl3zrHc+YS15LBJfmxj5jGQSGxm5m2oyd1ASIvEjTQzaca2wzwSNxLbGGccO5C7EajlID6/8M9Ifib5s63Onn9G+jOGDzV1ufPOHz744EcFbi0gwMyDYB8GkwfwqgcCxh8Idh0hxaNgFIyCUTACAQD5415Hb+afZwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-3250-6914","institution":"Linkou Chang Gung Memorial Hospital: Chang Gung Medical Foundation","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Cheng-Hsien","middleName":"","lastName":"Wu","suffix":""},{"id":41391523,"identity":"64df453d-0939-49d6-917c-df73d757afa8","order_by":1,"name":"Yon-Cheong Wong","email":"","orcid":"","institution":"Chang Gung Medical College: Chang Gung University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yon-Cheong","middleName":"","lastName":"Wong","suffix":""},{"id":41391524,"identity":"56f6ba6f-6fad-45c5-ac96-5d996c4e1f6a","order_by":2,"name":"Patricia Wanping Wu","email":"","orcid":"","institution":"Chang Gung Medical College: Chang Gung University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"Wanping","lastName":"Wu","suffix":""},{"id":41391525,"identity":"a993cbb7-4d16-4533-b49a-f4aecdf0828c","order_by":3,"name":"Ho-Yen Chueh","email":"","orcid":"","institution":"Chang Gung Medical College: Chang Gung University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ho-Yen","middleName":"","lastName":"Chueh","suffix":""}],"badges":[],"createdAt":"2021-07-14 05:45:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-714094/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-714094/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":11859769,"identity":"bc7bbcfb-c324-4764-9e31-9cf84c663c8a","added_by":"auto","created_at":"2021-07-27 21:41:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1999497,"visible":true,"origin":"","legend":"Pelvic angiography shows arterial aneurysms (arrows) with arteriovenous shunting to early draining veins (arrowheads) at both sides of the lower vagina.","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-714094/v1/f67f58b6a36f5ff1171b40a9.png"},{"id":11859768,"identity":"4468c389-a19c-42e9-850c-02bef2e2f0fb","added_by":"auto","created_at":"2021-07-27 21:41:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":734044,"visible":true,"origin":"","legend":"A.\tSelective angiogram of the right internal iliac artery clearly shows arterial aneurysm (arrow) with early drainage veins (arrowheads) fed by the internal pudendal artery. Similar findings are seen in the left internal iliac arteriogram\nB.\tSelective arterial embolization at the distal internal pudendal arteries with coils as presenting in this left internal pudendal artery.\n","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-714094/v1/1e5f6fd2c638ed1798dd2c71.png"},{"id":11859770,"identity":"bfeffc82-c46d-4296-bfbf-ef884c3a42a2","added_by":"auto","created_at":"2021-07-27 21:41:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":775470,"visible":true,"origin":"","legend":"A.\tMetallic coils (arrowheads) are deployed in the aneurysms involving both sides of the lower vagina. The inferior mesenteric artery (arrows) is pronounced and goes distally abutting to the vascular lesions. \nB.\tA followed-up angiogram arranged three months later, by which the vascular lesions totally obliterated and the inferior mesenteric artery regressed are disclosed.\n","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-714094/v1/342882cad202ade7559892ad.png"},{"id":13705895,"identity":"cd0c0f63-b949-4821-a5ee-ff1a3f154a06","added_by":"auto","created_at":"2021-09-17 13:54:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2732403,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-714094/v1/91042c3d-1c67-44f5-a8b6-a6155a826d1b.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eTrans-Arterial Embolization On A Catastrophic Primary Postpartum Hemorrhage Due To Arterial Aneurysm With Arteriovenous Fistula At Bilateral Lower Vagina: A Case Report\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePostpartum hemorrhage is a major cause of maternal morbidity and mortality, worldwide(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). PPH is often clinically assessed by the care givers, particularly at the emergent situation(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). The usual etiologies of PPH include genital tract laceration, uterus atony, uterine rupture, placenta retention, coagulopathy(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). Of these, the vascular injury and anomalies such as aneurysm, arteriovenous fistula (AVF) and arteriovenous malformation (AVM) are fierce culprits(\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e), and vagina arterial aneurysms with AVF in this presented case is rarely seen. Trans-arterial embolization (TAE) is an effective and minimally invasive procedure in managing the PPH(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). Here, we present a case of lower vaginal arterial aneurysm with AVF causing aggressive PPH successfully controlled by TAE after failure of the primary management.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 34-year-old woman with obstetric history of G3P0AA2 was 38\u0026thinsp;+\u0026thinsp;weeks pregnant and otherwise healthy. She was admitted for vaginal delivery after spontaneous rupture of the amniotic membranes. Primary post-partum hemorrhage (PPH) occurred after delivery; initial medical management was ineffective. After blood transfusion and vaginal packing with surgical pads, she returned to normotensive status temporarily. As vaginal bleeding persisted, angiography was performed by which arterial aneurysms with AVFs (Fig. 1) fed by the internal pudendal arteries (Fig. 2) were discovered at the bilateral lower vagina. Hemostasis was achieved by TAE of the aneurysms with metallic coils at each of the distal internal pudendal artery. After 5 days of hospitalization, she recovered well, and a rechecked angiography 3 months later revealed obliteration of the vascular lesions (Fig. 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe usual etiologies of PPH include genital tract laceration, uterus atony, uterine rupture, placenta retention, coagulopathy(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). Vascular injury or anomalies such as aneurysm, AVF and AVM are fierce culprits(\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e), and vaginal arterial aneurysm with AVF in this presented case is rarely seen. The clinical diagnosis of our presented case is pregnancy-related arterial aneurysms with AVFs at the lower vagina which contributes to the intractable primary PPH. Vaginal arterial aneurysm with AVF as a cause of PPH was not previously reported in English literature, and would render primary treatment methods ineffective. The diagnosis was made by angiographic picture of arterial aneurysms with early draining veins in the lower vagina. Anatomically, there are some arteries that supply the vagina; the anterior and lateral surfaces of the vagina are fed by the vaginal artery; the middle portion by the inferior vesicular artery; the lower part by the internal pudendal artery; and the posterior surface by the middle rectal artery(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe routine primary management for PPH includes resuscitation, blood transfusion, uterus controlling such as administration of uterotonic drugs, uterine compression, and intrauterine balloon tamponade. If the primary management fails, an intervention of TAE or surgical management should be initiated without any delay(\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e). The TAE was reported to be effective with a high success rate and was recommended to be first-line therapy to control PPH(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e). The most commonly used embolic material in TAE for PPH was gelatin sponge, and bail-out material could be metallic coils or N-butyl cyanoacrylate(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). At this uncommon condition of vaginal arterial aneurysms with AVFs causing PPH, small particle and liquid embolic material should be meticulously used in TAE, as they may increase the risk of IVC and pulmonary embolism owing to embolic material migration through the arterio-venous shunting.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eVascular anomaly of arterial aneurysms with AVFs at the bilateral lower vagina as a cause of PPH is rare and would make primary treatment unsuccessful. The obstetrician should be aware of the unusual lesions. TAE is especially important in detecting and treating this uncommon culprit.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthical Approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. Informed Consent for the percutaneous transarterial embolization was obtained from the patient. This case report has obtained IRB approval from \u0026ldquo;Chang Gung Medical Foundation Institutional Review Board\u0026rdquo;\u0026nbsp;and the need for informed consent was waived\u003c/li\u003e\n \u003cli\u003eConsent for Publication: Consent for publication was obtained for every individual person\u0026rsquo;s data included in the study\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials: Not applicable. It is a routine procedure encountered in our daily practice.\u003c/li\u003e\n \u003cli\u003eCompeting Interest: The authors have no competing interest to be declared\u003c/li\u003e\n \u003cli\u003eFunding: This study was not supported by any funding.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; contributions:\u0026nbsp;The authors have made substantive and specific intellectual contributions to this article and assume full responsibility for its content. Case reviewing by:\u0026nbsp;Cheng-Hsien Wu, Yon-Cheong Wong, Patricia Wanping Wu, Ho-Yen, Chueh. Journal research and reviewing by Cheng-Hsien Wu, Yon-Cheong Wong. Draft writing by Cheng-Hsien Wu, Patricia Wanping Wu. Clinical data collection and certification by Ho-Yen, Chueh.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAcknowledgements:\u0026nbsp;We want to thank the work of our radiological colleagues and all the staff at Chang Guang Memorial Hospital involved in the management of the case.\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; information (optional): as above mentioned\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Interv Radiol. 2010;33(5):887\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, et al. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG: an international journal of obstetrics gynaecology. 2010;117(10):1278\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFu CJ, Irama W, Wong YC, Tseng HJ, Wang LJ, Yeow KM, et al. Transarterial embolization for postpartum hemorrhage: lessons learned. Acta radiologica (Stockholm, Sweden: 1987). 2018;59(12):1451-7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, Lee SM, Kim JW, Shin JH. Recent Update of Embolization of Postpartum Hemorrhage. Korean J Radiol. 2018;19(4):585\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanahashi Y, Goshima S, Kondo H, Ando T, Noda Y, Kawada H, et al. Transcatheter Arterial Embolization for Primary Postpartum Hemorrhage: Predictive Factors of Need for Embolic Material Conversion of Gelatin Sponge Particles to N-Butyl Cyanoacrylate. Cardiovasc Interv Radiol. 2017;40(2):236\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim JE, So YH, Kim BJ, Kim SM, Choi YH, Sung CK. Postpartum hemorrhage from non-uterine arteries: clinical importance of their detection and the results of selective embolization. Acta radiologica (Stockholm, Sweden: 1987). 2018;59(8):932-8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Post-partum hemorrhage (PPH), arterial aneurysm, arteriovenous fistula (AVF), Trans-arterial embolization (TAE)","lastPublishedDoi":"10.21203/rs.3.rs-714094/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-714094/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Failure of the primary management at controlling the post-partum hemorrhage (PPH) is occasionally encountered. A catastrophic cause of PPH as vagina arterial aneurysms with AVF is rare and not reported in English literature.\u003c/p\u003e\u003cp\u003eCase presentations: We present a 34-year-old woman of arterial aneurysms with arteriovenous fistulas (AVF) at bilateral lower vagina causing intractable PPH with aggressive bleeding. By trans-arterial embolization (TAE) the bleeding is successfully controlled, and patient then could recover smoothly.\u003c/p\u003e\u003cp\u003eConclusion: These vascular anomalies being fierce culprit of the PPH would result in primary management failure. Knowledge of the possible etiology of post-partum hemorrhage is crucial for treatment management. This case report aims to point out a pivotal role of TAE at detecting and treating this unusual cause of PPH.\u003c/p\u003e","manuscriptTitle":"Trans-Arterial Embolization On A Catastrophic Primary Postpartum Hemorrhage Due To Arterial Aneurysm With Arteriovenous Fistula At Bilateral Lower Vagina: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-07-27 21:41:42","doi":"10.21203/rs.3.rs-714094/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2021-07-13T08:16:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-07-12T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-07-12T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2021-07-09T03:12:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88808dad-81d3-499d-b6b5-713507e42ca1","owner":[],"postedDate":"July 27th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":6001230,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2021-07-27T21:41:42+00:00","versionOfRecord":[],"versionCreatedAt":"2021-07-27 21:41:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-714094","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-714094","identity":"rs-714094","version":["v1"]},"buildId":"wLkW0s4AflPzk-lpfg-fK","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}