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Case Report
Large vulvar hematoma secondary to obturator artery pseudoaneurysm following uncomplicated vaginal delivery: A case report and review of the literature
1 Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Paulina J Haight
Department of Obstetrics and Gynecology, 5th Floor, 395 W. 12th Avenue, Columbus, Ohio 43210,
USA
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Article ID: 100079Z08PH2021
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Haight PJ, Kiefer M. Large vulvar hematoma secondary to obturator artery pseudoaneurysm following uncomplicated vaginal delivery: A case report and review of the literature. J Case Rep Images Obstet Gynecol 2021;7: 100079Z08PH2021.ABSTRACT
Introduction: Vulvovaginal hematoma and pseudoaneurysm of the pelvic vasculature are uncommon causes of postpartum hemorrhage. In this report we present the case of an obturator artery branch pseudoaneurysm causing puerperal vulvovaginal hematoma following uncomplicated vaginal delivery.
Case Report: We present the case of a 27-year-old multiparous patient who underwent uneventful vaginal birth after cesarean (VBAC) following preterm premature rupture of membranes (PPROM) at 36w4d gestation. Within the immediate postpartum period she developed a rapidly expanding vulvar hematoma, with subsequent acute blood loss anemia and hypotension. Computed tomography (CT) angiogram of the pelvis showed a pseudoaneurysm of a branch of the right obturator artery, and she underwent successful coil embolization with interventional radiology. Incision and drainage was performed the following day with evacuation of the hematoma, and significant improvement in edema and pain.
Conclusion: Obturator artery pseudoaneurysm is a rare cause of puerperal vulvovaginal hematoma that has not yet been described in the literature. We propose that CT angiography and arterial embolization should be considered in the setting of rapidly expanding puerperal vulvovaginal hematoma in a stable patient.
Keywords: Obturator artery pseudoaneurysm, Vulvar hematoma
SUPPORTING INFORMATION
Acknowledgments
Kara Rood MD, Maged Costantine MD, and Patrick Schneider MD
Author ContributionsPaulina J Haight - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Miranda Kiefer - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Paulina J Haight et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
