Figure 7a. Direct rupture of an arterial branch in a 33-year-old woman. The patient had massive vaginal bleeding during D&C for a therapeutic abortion. (a) Transverse gray-scale US image shows a markedly enlarged uterus (arrowheads) with large, heterogeneous hematomas (arrows) in the uterine cavity. (b) Longitudinal color Doppler US image shows slowly moving blood without fluctuation (arrows) within the hematomas, a finding suggestive of extravascular blood. (c) Left internal iliac angiogram shows extravasation of contrast medium (arrows) from branches of the left uterine artery. The uterus (arrowheads) is markedly enlarged by the hematomas. After arterial embolization with absorbable gelatin sponge pledgets, the bleeding stopped and did not recur.