Suspected Uterine Arterial Pseudoaneurysm in Secondary Postpartum Haemorrhage: A Case of Diagnostic Challenge and Successful Uterine Artery Embolisation

Secondary postpartum haemorrhage (PPH) has several causes, one of the less common and less often suspected being uterine artery pseudoaneurysm (UAP), a contained arterial wall defect causing massive, recurrent, life-threatening haemorrhage, typically following uterine trauma or Caesarean section.A 33year-old primiparous woman underwent emergency Caesarean section for failure to progress.She represented with secondary PPH on Day 5, and ultrasound with colour Doppler showed a high-flow, swirling intramyometrial lesion highly suspicious for UAP.Recurrent haemorrhage with haemodynamic instability on Day 8 required re-laparotomy and resuturing, which preserved the uterus.A further massive haemorrhage 21 days later prompted transfer to a tertiary centre.Total blood loss, including the Caesarean section, exceeded 7 L. Triple-phase CT and digital subtraction angiography (DSA) no longer demonstrated the lesion.Empirical bilateral uterine artery embolisation achieved durable haemorrhage control and preserved the uterus.This case highlights the value of ultrasound in raising early suspicion of UAP, the difficulty of confirming it after interim surgical haemostasis, and the feasibility of empirical embolisation as a uterus-preserving option.Embolisation remains effective and uterus-sparing when surgical management fails, underscoring the value of timely interventional radiology access.