It is estimated that more than 2% of pregnant women have hypothyroidism and that the incidence of treated hypothyroidism prior to pregnancy is around 0.3% of pregnancies. In the majority of cases, hypothyroidism is mild and is due to an autoimmune mechanism, as evidenced by the presence of anti-TPO or antithyroglobulin antibodies. Pregnancy may be indicative of a fruste form, related to asymptomatic autoimmune thyroiditis, which is unable to increase its hormone production to meet the specific needs of pregnancy. It can also be the consequence of moderate or severe iodine deficiency. Moreover, thyroid balance during pregnancy is essential for good fetal brain development. In fact, several studies have shown that children born to mothers who are not or insufficiently substituted for hypothyroidism have lower intelligence quotients than the general population. In addition, other maternal consequences (gravid hypertension, pre-eclampsia, etc.) and fetal consequences (IUGR, intellectual deficit) of hypothyroidism during pregnancy have been described. Although current recommendations suggest targeted screening of patients at risk of hypothyroidism, it is desirable that, in the near future, this screening becomes systematic as soon as the diagnosis of pregnancy is confirmed. L-thyroxine treatment should then be rapidly initiated (or adapted in the case of known hypothyroidism prior to pregnancy) with the aim of achieving a TSH of less than 2.5 mIU/l. In all cases, iodine supplementation should be offered from the preconceptional period through to breastfeeding.

Postpartum hemorrhage is a main cause of maternal death, it can be primary or secondary depending on the time of onset. Although less frequent, secondary haemorrhages keep a high morbidity and mortality rate, which is accentuated by the difficulty of diagnosis and determination of the etiologies especially in rare causes like the pseudo-aneurism of the uterine artery, a vascular abnormality in most cases caused by a traumatic lesion of the blood vessel most often during cesarean section. The diagnosis is examined in front of clinical and ultrasound elements, and confirmed by CT scan, MRI, or angiography which also allows therapeutic treatment thanks to embolization. We report the case of a 27-year-old patient who presented with late postpartum hemorrhage secondary to a pseudoaneurysm of the uterine artery, suspected by ultrasound and confirmed by CT scan, the patient underwent embolization with good evolution. Despite its rarity, pseudoaneurysm of the uterine artery is a potentially fatal complication and must be taken into account in the differential diagnosis of secondary postpartum hemorrhage allowing adequate and rapid management.