Postpartum haemorrhage requiring embolisation of a hypertrophied round ligament artery

Abstract

A gravida 4 para 1021, 41-year-old woman postcaesarean section at 39 weeks and 1 day with clinically significant haemorrhage required embolisation of unique uterine arterial collaterals. She had persistent haemorrhage after initial bilateral uterine artery embolisation, and on further investigation she was found to have a hypertrophied right round ligament artery. Once successful embolisation of this abnormal right round ligament artery was completed using a combination of Gelfoam and coils, haemostasis was achieved. She had rapid clinical improvement, no complications and no further admissions on postprocedural follow-up over a year and a half later.

Keywords: Interventional Radiology; Obstetrics And Gynaecology; Radiology.

Figure 1

Brisk contrast opacification of the bilateral uterine arteries (white arrows).

Figure 2

Angiography of the hypertrophied left uterine artery.

Figure 3

Aortography demonstrates sluggish filling of the hypertrophied left uterine artery status post-Gelfoam embolisation (white arrows), postcoil embolisation of a left internal iliac collateral vessel with absence of filling (black arrows) and a hypertrophied right hemipelvis artery presumed to be the right uterine artery (dashed white arrows) with active contrast blush (dashed black arrows).

Figure 4

Right uterine artery angiogram was performed demonstrating no active contrast blush.

Figure 5

Digital subtraction angiography, early arterial phase, demonstrating a hypertrophied right round ligament artery (dashed white arrows) and normal filling of the inferior epigastric artery (dashed black arrow).

Figure 6

Digital subtraction angiography, later arterial phase, demonstrating continued filling of a hypertrophied right round ligament artery (dashed white arrows) and normal filling of the inferior epigastric artery (dashed black arrow).

Figure 7

Azur CX coils (black arrows) with complete absence of filling of the round ligament artery and absence of contrast blush.

Figure 8

Digital subtraction angiography, later arterial phase, demonstrating azur CX coils (black arrows) with complete absence of filling of the round ligament artery and normal opacification of the inferior epigastric artery (dashed black arrow) and absence of contrast blush.