A potential mechanism for development of uterine artery pseudoaneurysm after delivery: An in-depth analysis of four cases

We present four distinct cases of uterine artery pseudoaneurysm (UAP) with secondary postpartum hemorrhage, in which their unique characteristics including the implicated arteries and their localization were delineated using contrast-enhanced computed tomography and uterine artery angiography. Three cases had a history of intrauterine manipulation procedures, which included in vitro fertilization/embryo transfer and surgical abortion. The UAPs emerged consistently at the placental attachment site. Notably, for the two cases with cesarean sections, the UAPs were formed in locations unrelated to myometrial incisions. These pseudoaneurysms manifested with radial or arcuate arteries. Three cases with extravasation exhibited hypofibrinogenemia and elevated D-dimer. These findings suggest that the intricate processes of placental attachment and detachment during pregnancy and delivery, possibly when combined with recognized predisposing factors including traumatic incidents prior to and/or during gestation and/or after parturition, may be associated with development of UAP. Consumptive coagulopathy may be a contributing factor for UAP extravasation.