Uterine artery pseudoaneurysm manifesting as postpartum hemorrhage after uneventful second-trimester pregnancy termination

Uterine artery pseudoaneurysm is a rare complication mainly of abdominal or interventional delivery that can cause profuse postpartum hemorrhage if unrecognized or inadequately treated. There has been no report of this disorder accompanying uneventful second-trimester pregnancy termination. A primiparous Japanese woman underwent pregnancy termination at 24 weeks' gestation due to fetal death. Gradual dilatation of the cervix followed by administration of vaginal gemeprost led to an uneventful delivery without curettage. After 41 days, profuse vaginal bleeding occurred. Ultrasound revealed a mass within the uterine cavity and color Doppler indicated the presence of high-speed flow within the mass. Selective angiography revealed that the mass was connected to the right uterine artery, from which extravasation was observed. Uterine artery pseudoaneurysm was diagnosed, and we performed successful uterine artery embolization. This is the first report of uterine artery pseudoaneurysm after second-trimester pregnancy termination. Our experience indicates that even after uneventful pregnancy termination, clinicians must remain aware of the possibility of pseudoaneurysm, manifesting as postpartum/post-termination hemorrhage.