Postpartum hemorrhage is an obstetric emergency and is a major preventable cause of maternal morbidity and mortality. An arteriovenous fistula is a rare cause of concealed postpartum hemorrhage.
A 20-year-old woman spontaneously delivered at 40 0/7 weeks of gestation. Twelve hours after delivery, she became hemodynamically unstable, developing a large left vaginal hematoma. An angiogram revealed extravasation originating from the right pudendal artery with early filling of a draining vein, consistent with a traumatic arteriovenous fistula. Complete occlusion of the fistula was achieved by embolizing a branch of the right pudendal artery. The postprocedure course was uneventful.
A vaginal arteriovenous fistula should be considered in cases of concealed postpartum hemorrhage; transcatheter arterial embolization is an effective treatment for these cases.