Abstract
Background: Post partum haemorrhage secondary to placenta accrete is a serious complication of childbirth. The current available treatment ranges from emergency hysterectomy to uterine artery embolisation. We describe a patient who presented with PPH in whom retained placenta accreta associated with vascular malformation was successfully treated with uterine artery embolisation together with review of literatures. Case Report: A 38-year old nulliparus presented with significant post partum haemorrhage of 3.6 Liters, intially controlled by packing. Five weeks post partum, the patient presented with recurrent unprovoked bleed. Ultrasound and Magnetic Resonance Angiography (MRA) were demonstrated retained placental tissue with dilated vessels and increased vascular flowconsistent with retained placenta accreta and vascular malformation. First session embolisation was performed using Embospheres particles 700-900 microns (Merit Medical Inc., USA). A second embolisation procedure was carried out via the left CFA using micro coils (Boston Scientific, Watertown, MA, USA) and gelfoam pledges until complete occlusion was achieved. Two months post-partum, the patient presented complaining of foul smelling vaginal discharge, due to necrotic placenta and received full course of antibiotics with dilatation and curettage. Follow-up US demonstrated no residual vascular malformation. Conclusions: Placenta accreta and uterine AVMs are recognised causes of uterine bleeding. Uterine artery embolization is an alternative treatment for uncontrolled postpartum haemorrhage and an effective treatment for acquired AVM's outside of pregnancy. Publication Date: 26 April 2021 (online) © 2017. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India