Postpartum Ovarian Vein Bleeding after Instrumental Delivery

Background: Retroperitoneal hemorrhage in obstetric is rare which can lead to maternal morbidity and mortality. It can develop spontaneously during pregnancy and puerperium as a result of trauma, anticoagulation therapy, coagulation disorders, injury of uterine and ovarian vessels.

Case: A 30-year-old Saudi woman, gravida 2, para 2, postinstrumental delivery 2 days ago, complaining of sudden lower abdominal pain with drop of hemoglobin level by 4 g. CT revealed retroperitoneal hemorrhage with active contrast extravasation from the right gonadal vein extending to the right paracolic gutter. We did for her venogram under fluoroscopy accessed by right brachial vein puncture, which revealed large dilated tortuous right ovarian vein with active bleeding distally. Long vascular sheath was inserted and parked at the origin of the right ovarian vein to prevent any coil migration, then utilizing angled catheter, the right ovarian vein was embolized using multiple coils with different sizes. The patient discharged after 3 days in good health.

Discussion: The diagnoses of postpartum hemorrhage are based on the collective of information gathered from the clinical presentation, laboratory, and radiological findings. Percutaneous vascular embolization has shown its effectiveness in treating many obstetrical and gynecological causes of bleeding.

Publication History

Article published online:
09 February 2023