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CLC number: R737.33

On-line Access: 2017-05-04

Received: 2016-11-24

Revision Accepted: 2017-01-29

Crosschecked: 2017-04-10

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Journal of Zhejiang University SCIENCE B 2017 Vol.18 No.5 P.441-444

http://doi.org/10.1631/jzus.B1600528


Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm


Author(s):  Ning Zhang, Wei-hua Lou, Xue-bin Zhang, Jian-hua Lin, Wen Di

Affiliation(s):  Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China; more

Corresponding email(s):   diwen163@163.com

Key Words:  Postpartum hemorrhage, Antepartum hemorrhage, Uterine artery pseudoaneurysm


Ning Zhang, Wei-hua Lou, Xue-bin Zhang, Jian-hua Lin, Wen Di. Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm[J]. Journal of Zhejiang University Science B, 2017, 18(5): 441-444.

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author="Ning Zhang, Wei-hua Lou, Xue-bin Zhang, Jian-hua Lin, Wen Di",
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doi="10.1631/jzus.B1600528"
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%T Antepartum hemorrhage from previous-cesarean-sectioned uterus as a potential sign of uterine artery pseudoaneurysm
%A Ning Zhang
%A Wei-hua Lou
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%A Wen Di
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A1 - Ning Zhang
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A1 - Wen Di
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Abstract: 
postpartum hemorrhage (PPH), a leading cause of maternal mortality, can occur within 24 h of delivery (primary PPH), or during the period from 24 h after delivery to Week 6 of puerperium (secondary PPH). It requires health professionals to be alert to the symptoms to ensure prompt diagnosis and treatment, especially in the case of rupture of a uterine artery pseudoaneurysm (UAP) due to its life-threatening consequence (Baba et al., 2014). Most of the published case reports or case serials describe UAP as a possible cause of delayed PPH after traumatic procedures during delivery or pregnancy termination, including cesarean section (CS), manual removal of the placenta, or dilation and curettage (D&C) (Wald, 2003). Herein, we report a case of prior CS-related UAP manifesting as primary PPH after an uncomplicated vaginal delivery. This case required emergency embolization and is notable for several reasons. antepartum hemorrhage of the previously scarred uterus was a potential sign of the ruptured UAP, and color Doppler sonography sometimes deceived the physician as the characteristic features of UAP did not appear to be present.

疤痕子宫产前出血可能是子宫动脉瘤的潜在危险信号

目的:子宫动脉瘤多被认为与产程中创伤性操作相关,但近年陆续有报道显示子宫动脉瘤可发生于自然分娩过程中。本文将为自然分娩过程中子宫动脉瘤的发生和紧急处理等提供参考指导。
创新点:产前出血可能是子宫动脉瘤发生的潜在危险信号。
方法:病例报道和文献汇纳分析。患者女,37岁,疤痕子宫,临产入院,产前出血,经阴顺产后12 h,突发阴道大量出血,常规对症处理(按摩子宫、阴道填塞、缩宫素静滴和欣母佩宫颈注射等)未能有效缓解,40 min内出血达1800 ml。床边B超未提示动脉瘤特征,数字减影血管造影(DSA)显示左侧子宫动脉瘤,即刻予动脉栓塞成功止血。患者产后4 d无并发症出院,随访无后遗症。
结论:临床医师需要加强对子宫动脉瘤发生的警惕认识和急救处理水平。子宫动脉瘤和产程中的有创性操作无必然相关性,疤痕子宫的产前出血可能是子宫动脉瘤发生的潜在危险信号,产后随访应提高对晚期出血发生的警惕性。鉴于B超在诊断动脉瘤方面的有限性,高度怀疑动脉瘤时应尽快行血管造影明确诊断,及时栓塞处理。

关键词:子宫动脉瘤;经阴分娩;早期产后出血;动脉栓塞

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Reference

[1]Baba, Y., Matsubara, S., Kuwata, T., et al., 2014. Uterine artery pseudoaneurysm: not a rare condition occurring after non-traumatic delivery or non-traumatic abortion. Arch. Gynecol. Obstet., 290(3):435-440.

[2]Baba, Y., Takahashi, H., Ohkuchi, A., et al., 2016. Uterine artery pseudoaneurysm: its occurrence after non-traumatic events, and possibility of “without embolization” strategy. Eur. J. Obstet. Gynecol. Reprod. Biol., 205:72-78.

[3]Cornette, J., van der Wilk, E., Janssen, N.M., et al., 2014. Uterine artery pseudoaneurysm requiring embolization during pregnancy. Obstet. Gynecol., 123(2 Pt 2):453-456.

[4]Dohan, A., Soyer, P., Subhani, A., et al., 2013. Postpartum hemorrhage resulting from pelvic pseudoaneurysm: a retrospective analysis of 588 consecutive cases treated by arterial embolization. CardioVasc. Intervent. Radiol., 36(5):1247-1255.

[5]Gondo, S., Urushiyama, D., Yoshizato, T., et al., 2014. The successful detection of postpartum unruptured vaginal pseudoaneurysm using ultrasonography: a case report. SpringerPlus, 3(1):482.

[6]Matsubara, S., Nakata, M., Baba, Y., et al., 2014a. Uterine artery pseudoaneurysm hidden behind septic abortion: pseudoaneurysm without preceding procedure. J. Obstet. Gynaecol. Res., 40(2):586-589.

[7]Matsubara, S., Kuwata, T., Usui, R., et al., 2014b. Uterine artery pseudoaneurysm: a master of deception. Arch. Gynecol. Obstet., 289(3):469-470.

[8]Matsubara, S., Takahashi, H., Ogoyama, M., et al., 2016. Postpartum hemorrhage: is angiographically detectable “sac” mandatory for diagnosis of ruptured pseudoaneurysm? Arch. Gynecol. Obstet., 293(6):1361-1362.

[9]McGonegle, S.J., Dziedzic, T.S., Thomas, J., et al., 2006. Pseudoaneurysm of the uterine artery after an uncomplicated spontaneous vaginal delivery. J. Ultrasound Med., 25(12):1593-1597.

[10]Soyer, P., Fargeaudou, Y., Morel, O., et al., 2008. Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur. Radiol., 18(6):1181-1187.

[11]Soyer, P., Dohan, A., Dautry, R., et al., 2015. Transcatheter arterial embolization for postpartum hemorrhage: indications, technique, results, and complications. CardioVasc. Intervent. Radiol., 38(5):1068-1081.

[12]Wald, D.A., 2003. Postpartum hemorrhage resulting from uterine artery pseudoaneurysm. J. Emerg. Med., 25(1): 57-60.

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