Uterine artery pseudoaneurysm: a rare cause of secondary postpartum haemorrhage following caesarean section

A 30-year-old woman, para 2, who underwent an uneventful repeat elective lower segment caesarean section with sterilisation presented on the 23rd postnatal day to our Obstetric Emergency department with profuse bleeding per vaginum. She had a similar bout of bleeding on the 19th postnatal day and was treated elsewhere with blood transfusion and uterotonics. On ultrasonography, she was diagnosed to have few retained adherent placental bits in the lower part of the uterus with a small left broad ligament haematoma and hence was injected with a single dose of methotrexate. A communication of uterine artery was suspected as the mass was close to the uterus and few pulsations were felt on per vaginal examination while attempting aspiration of haematoma. Uterine artery pseudoaneurysm was diagnosed by Doppler studies and confirmed by contrast enhanced CT. She was treated successfully by bilateral internal iliac artery ligation as facilities for embolisation are not available.