Large vulvar hematoma secondary to obturator artery pseudoaneurysm following uncomplicated vaginal delivery: A case report and review of the literature

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. Paulina J Haight1, MD, Miranda Kiefer1, DO Affiliation: 1Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Corresponding Author: Paulina J Haight, Department of Obstetrics and Gynecology, 5th Floor, 395 W. 12th Avenue, Columbus, Ohio 43210, USA; Email: paulina.haight@osumc. edu Received: 22 February 2021 Accepted: 30 April 2021 Published: 04 June 2021