Rupture of pseudoaneurysm after vaginal delivery successfully treated by selective arterial embolization

Rupture of a pseudoaneurysm after vaginal delivery is a rare cause of postpartum hemorrhage. A 29-year-old primigravida delivered a healthy boy by vacuum extraction at 38 weeks of gestation. The patient underwent repair of a right mediolateral episiotomy and left vaginal wall laceration. On the third postpartum day she experienced massive vaginal bleeding with vaginal wall laceration, and the vaginal bleeding progressively increased. A selective angiogram of the left internal iliac artery showed a pseudoaneurysm with extravasation originating from the left internal pudendal artery. Complete occlusion of the pseudoaneurysm was achieved by embolization of the left internal pudendal artery. The postprocedural course was uneventful. A pseudoaneurysm should be considered in unclear cases of postpartum hemorrhage.