A Rare Case of Uterine Artery Pseudoaneurysm Causing Secondary Postpartum Hemorrhage Following Cesarean Section - A Diagnostic and Management Challenge in a Resource-Limited Setting

Sep 29, 2026

Uploaded by Oliver

Uterine artery pseudoaneurysm (UAP) is a rare but potentially fatal cause of delayed postpartum hemorrhage, often after cesarean delivery. A 35-year-old woman developed abnormal vaginal bleeding 2 days after cesarean section, with a significant hematocrit drop and ongoing blood loss. Diagnosis was supported by abdominal ultrasound and CT, confirming a thrombosed UAP at the surgical site. Hysterectomy was required when uterine artery embolization services were unavailable, enabling discharge in stable condition.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Case Report

Introduction

Case Presentation

Investigation and Treatment

Outcome and FollowUp

Discussion

Clinical Case Reports CASE REPORT OPEN ACCESS A Rare Case of Uterine Artery Pseudoaneurysm Causing Secondary Postpartum Hemorrhage Following Cesarean Section: A Diagnostic and Management Challenge ina Resource-Limited Setting Gebreegziabher Hailay1 | Rabirra Waktola2 | Abay Eyayu3 1Department of Radiology and MRT, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia | 2Department of Radiology, Ambo University, Ambo, Ethiopia | 3Department of Gynecology and Obstetrics, Gondar University, Gondar, Ethiopia Correspondence: Rabirra Waktola ([rabirrawak@gmail.com](rabirrawak@gmail.com)) Received: 2 July 2025 | Revised: 29 November 2025 | Accepted: 21 December 2025 Keywords: cesarean section | color doppler ultrasound | resource-limited setting | secondary postpartum hemorrhage | uterine artery pseudoaneurysm | ABSTRACT
Uterine artery pseudoaneurysm (UAP) is a rare, potentially fatal cause of delayed postpartum hemorrhage, often following cesarean sections. Here we present a 35-year-old woman for whom hysterectomy was done after she presented with delayed vaginal bleeding 2 days post-cesarean section due to uterine artery pseudoaneurysm which was confirmed by abdominal ultrasound and CT imaging. | | | --- | --- | | 1 | Introduction | 2 | Case Presentation | | The pseudoaneurysm often consists of only one layer of loose | A 35-year-old woman, gravida 4, para 3, underwent a primary | | connective tissue, distinguishing it from a true aneurysm, which | lower transverse cesarean section for cephalopelvic dispropor- | | is a dilatation of a vessel with all three layers of the vessel wall | tion due to fetal macrosomia, delivering a healthy male neonate | | [1] . The pseudoaneurysms are commonly encountered in car- | weighing 4.5 kg. On the second postoperative day, she developed | | diac, femoral artery, visceral artery, and aortic wall [2] . Uterine | abnormal vaginal bleeding and a significant drop in hematocrit | | artery pseudoaneurysm (UAP) is a rare but potentially life- | (hemoglobin of 7 g/dL), suggesting ongoing hemorrhage. The | | threatening complication that can occur following uterine trau- | patient required a blood transfusion to maintain hemodynamic | | mas like cesarean section, myomectomy, subtotal hysterectomy, dilatation and curettage, and vaginal delivery [3–6] . It is characterized by the formation of an extraluminal collection of blood | stability. | | with a turbulent flow that communicates with flowing arterial blood through a defect in the arterial wall [7] . Extraluminal tur- | 3 | Investigation and Treatment | | bulent blood flow can lead to enlargement of the UAP, making it | Imaging with transabdominal ultrasound (Figure 1) showed a | | susceptible to rupture and subsequent bleeding [8] . On the con- | peripherally slightly hyperechoic lower uterus myometrial lesion | | trary, uterine AVM is very rare, characterized by bypassing of | (arrows on Figure 1 images A and B) that has centrally yin yang | | the capillary network between the uterine arterial and venous | flow on color doppler study (arrowhead on Figure 1 image B). | | supply. Uterine AVM may be congenital or acquired, detected following surgical intervention on the uterus, such as cesarean | The periphery has no color doppler flow indicating thrombus (red arrow in Figure 1 image B). Pre and post contrast abdominopelvic | | section, uterine dilation, and curettage [8] . | CT (Figure 2 images A and B, red arrows) showed a peripherally | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. | | Clinical Case Reports, 2026; 14:e71790 1 of 4 [https://doi.org/10.1002/ccr3.71790](https://doi.org/10.1002/cc

FAQs

What complication followed the cesarean section in this case?

The patient developed a uterine artery pseudoaneurysm causing secondary postpartum hemorrhage with delayed abnormal vaginal bleeding.

How was the uterine artery pseudoaneurysm diagnosed?

Transabdominal ultrasound with color Doppler and contrast-enhanced CT confirmed a thrombosed uterine artery pseudoaneurysm at the cesarean site.

Why was total abdominal hysterectomy performed?

Uterus-sparing measures (bilateral uterine artery ligation and compression sutures) failed to control the bleeding, and uterine artery embolization services were unavailable.

Sep 29, 2026

Uploaded by Oliver