Rupture of internal pudendal artery aneurysm following spontaneous vaginal delivery: An uncommon cause of post-partum bleeding

Pregnancy-related rupture of an arterial aneurysm is an unusual occurrence associated with increased risk of morbidity and mortality. Various pregnancy-related physiologic changes appear to make pregnancy a high-risk situation for rupture of either preexisting arterial aneurysms or those that develop throughout the course of pregnancy. Splenic artery aneurysms are the most common (60%), followed by hepatic (20%), superior mesenteric (5.9%), celiac (4%), ovarian, uterine, and renal (<2%) artery. Even rarer are aneurysms involving the internal iliac artery and its branches, to which there is only one published case report. In this report, we present a case of a 34-year-old pregnant gravida1 para0 who, following a normal vaginal delivery, had a severe rupture of the right internal pudendal artery and subsequently developed a massive hematoma which ultimately required embolization treatment.

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Rupture of an ovarian artery aneurysm following normal vaginal delivery

South African Journal of Radiology ◽

10.4102/sajr.v15i2.327 ◽

2011 ◽

Vol 15 (2) ◽

pp. 50-51

Author(s):

F Van Schouwenburg ◽

H Lameen

Keyword(s):

Ct Scan ◽

Vaginal Delivery ◽

Fluid Collection ◽

Artery Aneurysm ◽

Abdominal Ultrasound ◽

Normal Vaginal Delivery ◽

Ovarian Artery ◽

Contrast Enhanced Ct ◽

Inferior Border ◽

The Right

A 30 year-old woman presented at the casualty department 12 days after having given birth to a healthy baby via normal vaginal delivery. She complained of increasing pain and a mass in her right flank. There were no complaints of nausea, vomiting, dysuria or abnormal bowel habits. On examination, the patient was acutely distressed, in severe pain and was anaemic with an Hb of 5 g/dl. Her blood pressure was 151/71 mmHg and her pulse rate 125/minute. Physical examination revealed a severely distended abdomen with features of peritonitis. An abdominal ultrasound revealed a large abdominal fluid collection and a CT scan was therefore requested. A contrast-enhanced CT scan demonstrated a large homogenous retroperitoneal fluid collection in the right flank, with a 25mm rounded, intensely enhancing focus located close to the inferior border of the collection. The collection displaced the bowel to the left and inferiorly, and the liver, superiorly. The differential diagnosis included a ruptured ovarian artery aneurysm. As soon as the patient was stable, she was taken for ovarian artery embolization that was successfully accomplished. The patient recovered well in the ward.

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On demand caesarean section: What’s women’s attitude?

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v2i2.1448 ◽

1970 ◽

Vol 2 (2) ◽

pp. 12-15

Author(s):

Nira S Shrestha ◽

Sumita Pradhan

Keyword(s):

Caesarean Section ◽

Pregnant Women ◽

Vaginal Delivery ◽

Caesarean Delivery ◽

Mode Of Delivery ◽

University Teaching ◽

Normal Vaginal Delivery ◽

On Demand ◽

Assisted Delivery ◽

The Right

Objectives: To evaluate the knowledge and attitude of Nepalese women towards mode of delivery and caesarean on demand. Study design: Hospital based cross sectional descriptive study where 200 pregnant women after 37 completed weeks of gestation were recruited randomly and interviewed, and their answers were analyzed. Results: Of the 200 interviewed pregnant women, all of them knew about normal vaginal delivery and caesarean delivery, but only 30% knew about instrumentally assisted delivery and 9% had heard about painless labour. Vaginal delivery was the preferred mode in 93% and 7% preferred caesarean delivery. Only 35% of the interviewed women believed that women should have the right to demand a caesarean section Conclusion: Knowledge assessment of two hundred women regarding the mode of delivery clearly indicates the need for strengthening counseling aspect of antenatal care and awareness program regarding mode of delivery. In Nepal on demand caesarean section is not provided in the University Teaching Hospital. However one third of women still felt that women should have the right to choose caesarean section on demand. Key words: Attitude, mode of delivery, Caesarean on demand. doi:10.3126/njog.v2i2.1448 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 12 - 15

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Anemia in antenatal patients and its outcome: an experience in tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183328 ◽

2018 ◽

Vol 7 (8) ◽

pp. 3263

Author(s):

Shabnam Ara ◽

Cimona Lyn Saldanha ◽

Insha Khan

Keyword(s):

Vaginal Delivery ◽

Serum Ferritin ◽

Peripheral Blood ◽

Post Partum ◽

Tertiary Care ◽

Deficiency Anemia ◽

Normal Vaginal Delivery ◽

Blood Picture ◽

Co Morbidity ◽

Term Delivery

Background: Anemia is the most common hematological abnormality detected during the pregnancy and forms a major problem in affecting the females especially in the developing countries.Methods: All pregnant females with clinical evidence of anemia without any other co-morbidity attending the antenatal clinic were included in the study. Patients were studied in terms of the age, parity, inter-pregnancy spacing, type of pregnancy, post-partum outcome along with the biochemical tests like peripheral blood picture, hemoglobin estimation, and serum ferritin levels.Results: Total no. of patients was 500, age ≤20 years were 60 and ≥35 years were 107, mild anemia (10-10.9 gm%) 160, moderate anemia (7-10 gm%) 250, severe anemia (<7 gm%) 90. Normal vaginal delivery with medio-lateral episiotomy was done in 385 patients, normal vaginal delivery without medio-lateral episiotomy in 35 while lower-segment caesarean section in 80 patients. Pre-term delivery was done in 95 patients, post-term delivery in 20. 90 babies delivered were low-birth weight (<2500 gm), antepartum hemorrhage was seen in 10 patients while 20 patients had Post-partum hemorrhage.Conclusions: The present study concludes that anemia is still rampant in the society especially in pregnant women. The main cause of anemia-in-pregnancy is still the iron deficiency anemia. The peripheral blood picture, hemoglobin estimation, and serum ferritin levels form the basic pillars in the evaluation of the etiology and type of anemia. The multiple government sponsored facilities are to be made available to each pregnant female and that requires community, government as well as healthcare professional’s participation.

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Induction of labour and its feto-maternal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193037 ◽

2019 ◽

Vol 8 (7) ◽

pp. 2748

Author(s):

Mridu Sinha ◽

Shashi Bala Arya ◽

Shashi Saxena ◽

Nitant Sood

Keyword(s):

Vaginal Delivery ◽

Statistical Tests ◽

Post Partum ◽

Tertiary Care ◽

Relative Effect ◽

Induction Of Labour ◽

Labour Induction ◽

Time Period ◽

Increased Risk ◽

One Year

Background: Induction of labour is an iatrogenic deliberate attempt to terminate the pregnancy in order to achieve vaginal delivery in cases of valid indication. It should be carefully supervised as it is a challenge to the clinician, mother and the fetus. Aim of this study was to find out common indications for IOL in a tertiary care teaching centre and its feto-maternal outcome.Methods: An institutional based retrospective observational study was conducted to describe the prevalence of labour induction and factors associated with its outcome, during the time-period of one year from January 2018 to December 2018, at SRMS IMS, Bareilly. Logistic regression analysis was employed to assess the relative effect of determinants and statistical tests were used to see the associations.Results: Most of the patients were primigravidas of younger age-group. Idiopathic oligohydramnios and postdatism were the commonest indications for induction of labour and Misoprost was the commonest drug used for it. Though majority had vaginal delivery, as the method was changed to combined method it was significantly associated with increased likelihood of LSCS. Similarly there was increased association with maternal cervico-vaginal tear / lacerations as the method was changed to combined type. However there were no association between post-partum hemorrhage, meconium stained liquor or fetal distress.Conclusions: Common indications for induction of labour were oligohydramnios and postdatism. Misoprost can be safely used for induction of labour without any increased risk for LSCS or any fetal / neonatal risks.

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A Unique Indication for the Altura Endograft to Repair Bilateral Common Iliac Artery Aneurysms Associated with a Short–Infrarenal Aorta

Aorta ◽

10.1055/s-0040-1702142 ◽

2020 ◽

Vol 08 (02) ◽

pp. 041-045

Author(s):

Stavros K. Kakkos ◽

Chrysanthi P. Papageorgopoulou ◽

Konstantinos Katsanos ◽

Peter Zampakis ◽

Athina Siampalioti ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Artery Aneurysm ◽

Infrarenal Aorta ◽

Iliac Artery Aneurysm ◽

Internal Iliac ◽

The Right ◽

Stage Renal Disease ◽

End Stage ◽

Tomographic Angiography

AbstractA 71-year-old man with end-stage renal disease on hemodialysis presented with bilateral common iliac artery aneurysms diagnosed during the workup of his chronic kidney disease. On computed tomography angiography, common iliac artery aneurysm diameters measured 6.1 cm on the right side and 3.1 cm on the left side. The infrarenal aorta also had a small 3.2-cm aneurysm, but the length from the lowest left renal to the aortic bifurcation was only 6.7 cm, precluding use of most bifurcated endografts. Following an uneventful staged preoperative internal iliac artery embolization, a two-piece D-shaped Altura endograft for the aorta, with bilateral iliac components, landing at the level of the external iliac arteries was successfully performed. Postoperative course was uneventful with no endoleak or endograft migration on computerized tomographic angiography 45 days later, although billowing mimicking an endoleak was evident and will be closely followed.

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Unusual Representation of a Common Iliac Artery Double Aneurysm

Journal for Vascular Ultrasound ◽

10.1177/154431671704100305 ◽

2017 ◽

Vol 41 (3) ◽

pp. 129-134

Author(s):

Janine Oliveri

Keyword(s):

Abdominal Aorta ◽

Iliac Artery ◽

Coil Embolization ◽

Common Iliac Artery ◽

Artery Aneurysm ◽

Ultrasound Screening ◽

Vascular Surgeon ◽

Ultrasound Study ◽

Internal Iliac ◽

The Right

This case discusses an unusual representation of a 3.1-cm double aneurysm of the right common iliac artery with an ectatic distal abdominal aorta. The patient was a 64-year-old asymptomatic male who participated in a routine ultrasound screening at his church. On the basis of the findings, a full ultrasound study was ordered and conducted at the request of his primary physician. The patient's history included smoking cessation in 1975. He currently had hypertension and hyperlipidemia. He was physically active and ran 40 miles per week until developing right Achilles tendonitis. Because of this injury, the patient biked daily. The patient's medications included atenolol and daily vitamins. The ultrasound findings revealed two aneurysms of the right common iliac artery. Both areas were fusiform and measured 3.1 and 2.9 cm, respectively. The dilation extended to the right internal iliac artery. The left common iliac was mildly dilated and kinked to the left. There was mild enlargement of the distal abdominal aorta measuring 3.4 cm by ultrasound and 3.1 cm by computed tomography angiogram. There is no evidence of internal thrombus. Usually asymptomatic, iliac artery aneurysms can be lethal if large (above 3.0 cm) and undetected. With appropriate, timely intervention the aneurysm can be safely repaired before rupture. Various aneurysm treatment options include conventional open abdominal surgery or endovascular stent graft placement with coil embolization. This patient discussed options with the vascular surgeon and was scheduled to have a cardiac catheterization with right internal iliac coil embolization. Staging of the endovascular graft was planned to follow. This case presents the uncommon finding of a large iliac artery aneurysm. This patient's disease was made more unusual by the presence of two distinct aneurysms present within the same vessel. It further reinforces the common practice of fully examining patients with aneurismal disease bilaterally and over multiple levels as a significant portion of patients have multilevel disease.

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Fornix Rupture in Duplex Kidney due to Internal Iliac Artery Aneurysm

Case Reports in Urology ◽

10.1155/2016/5042456 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Phitsanu Mahawong ◽

Tanop Srisuwan ◽

Kittipan Rerkasem

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Artery Aneurysm ◽

Abdominal Ultrasound ◽

Selective Embolization ◽

Iliac Artery Aneurysm ◽

Duplex Kidney ◽

Internal Iliac Artery Aneurysm ◽

Internal Iliac ◽

The Right

A 70-year-old man presented with severe pain on the right side of the abdomen for 7 days. An abdominal CT angiographic scan showed an impending rupture of a large right internal iliac artery aneurysm which compressed to a right ureter causing hydroureteronephrosis. Fornix rupture of a right duplex kidney was also detected. Selective embolization of right gluteal arteries and then ligation of the right internal iliac artery and right ureterotomy with double J stenting were performed. At the 4-month follow-up appointment, an abdominal ultrasound demonstrated a decrease in the size of the aneurysm and no hydroureteronephrosis after the removal of double J stent.

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The Prevalence and Risk Factors of Post-Partum Haemorrhage in Africa: A systematic review.

10.21203/rs.2.19608/v1 ◽

2019 ◽

Author(s):

Prince Leornad Bestman ◽

Xiongfeng Pan ◽

Jiayou Luo

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Vaginal Delivery ◽

Prevalence Rate ◽

Postpartum Haemorrhage ◽

Post Partum ◽

Future Research ◽

Increased Risk ◽

Post Partum Haemorrhage ◽

Associated Risk Factors

Abstract Background Postpartum Haemorrhage is the loss of blood that is 500 ml or greater than 500ml following a vaginal delivery or blood loss that is more than or equivalent to 1000 ml post-caesarean section. Post-partum Haemorrhage is the leading cause of maternal mortality, and to our knowledge, there is less evidence of a systematic review being published on the prevalence and associated risk factors of PPH in Africa. Additionally, findings from previous studies about the prevalence and risk factors of PPH in Africa are controversial. Therefore, we aimed to assess the prevalence and risk factors of PPH in Africa, so as to provide scientific evidence base findings that might be used to ensure maternal safety. Methods: We conducted a systematic review of the prevalence and risk factors of Postpartum haemorrhage in Africa. Four electronic databases were searched for published observational and cross-sectional studies that reported on the prevalence and risk factors of PPH in Africa. Simple manual arithmetic calculation and descriptive critical reasoning were used to analyse pooled data on PPH prevalence and its associated risk factors in Africa. Results: A total of 2005 publications were retrieved from our search, out of which 162 articles were selected for full-text review. A total of 12 studies met the inclusion criteria for this systematic review. All the included studies reported relatively different prevalence rates of PPH in Africa, ranging from 1.13% in Nigeria to 23.63% in Cameroon. This Review found the overall prevalence rate of PPH in Africa to be 3.51%. Nearly all the studies provided similar associated risk factors of PPH in Africa, but these risk factors vary relatively in the magnitude of association from one country to another. Notwithstanding, this review found: spontaneous vaginal delivery, older maternal age, and multiparty to be associated with increased risk of PPH in Africa. Conclusion: We found that the PPH prevalence rate is lower than 4% in Africa and that its risk factors vary relatively in the strength of association from one geographical region to another. We suggest that future research focus on PPH prevention and control to ensure maternal and child safety.

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