Case 2 A 32- year- old patient gravid 2 para1, under contraception. She was admitted for torrential vaginal bleeding 6 month after cesarean section. She had a history of postpartum hemorrhage and fever, 48 hours post cesarean of a fetal macrosomia. Also she has a history of curettage. At day 42 postpartum, 2 hours earlier her admission, she had a massive vaginal bleeding, dizziness and syncope. She was clinically stable. On gynecological examination, the vulva was bloody, blood clots within the vagina, cervix smooth and closed no active bleeding and the uterus such as the size of 2 months pregnant, more than accepted. The estimated blood loss at admission about 1000ml, Hemoglobin 94g / l , white blood cell count 19.45 x 10 ^ 9 / L, with normal
…show more content…
The blood pressure 83 / 40mmHg, she was conscious with anemia appearance, tachypnea, normal thoracic and abdominal examination, moreover, the gynecological examination noted a large number of blood clots emerging from the …show more content…
The color Doppler ultrasound displayed a normal uterine size, empty, presence of cesarean scar which has a cystic and tubular structure with the surge of cloudy blood flow signals, suggesting a vasoactive bleeding. The diagnosis of uterine arteriovenous fistula was made; similarly Digital subtraction angiography (DSA) sees circular contrast agent stagnation at the right side of the uterine artery and confirmed the diagnosis. Consequently, the embolotherapy was performed to the right uterine artery with fresh gelatin sponge particles. The first day after intervention, she presents a heavy hemorrhage, the medical staff decided to perform a laparoscopic excision of the fistula stump and repair the uterine. 8 day thereafter, under general anesthesia a hysteroscopy was performed during which a sinus-like defect, about 2.0cm in diameter, surrounded by a thick white line has been found on the cervix orifice at 9 o'clock, extending at the right side of the uterine isthmus, also the right side of the uterine wall had old blood clots and arterial fluctuations as
The blood pressure 83 / 40mmHg, she was conscious with anemia appearance, tachypnea, normal thoracic and abdominal examination, moreover, the gynecological examination noted a large number of blood clots emerging from the …show more content…
The color Doppler ultrasound displayed a normal uterine size, empty, presence of cesarean scar which has a cystic and tubular structure with the surge of cloudy blood flow signals, suggesting a vasoactive bleeding. The diagnosis of uterine arteriovenous fistula was made; similarly Digital subtraction angiography (DSA) sees circular contrast agent stagnation at the right side of the uterine artery and confirmed the diagnosis. Consequently, the embolotherapy was performed to the right uterine artery with fresh gelatin sponge particles. The first day after intervention, she presents a heavy hemorrhage, the medical staff decided to perform a laparoscopic excision of the fistula stump and repair the uterine. 8 day thereafter, under general anesthesia a hysteroscopy was performed during which a sinus-like defect, about 2.0cm in diameter, surrounded by a thick white line has been found on the cervix orifice at 9 o'clock, extending at the right side of the uterine isthmus, also the right side of the uterine wall had old blood clots and arterial fluctuations as