Women’s Imaging

Abstract

Postpartum hemorrhage is one of the leading causes of maternal mor-tality worldwide. According to the time when postpartum hemorrhage develops, it is classified as (a) primary, or early, postpartum hemor-rhage (within the first 24 hours after delivery) or (b) secondary, or late, postpartum hemorrhage (>24 hours to 6 weeks after delivery). Primary postpartum hemorrhage may be caused by uterine atony (75%–90% of cases), trauma of the lower portion of the genital tract, uterine rupture, uterine inversion, bladder flap hematoma, retention of blood clots or placental fragments, and coagulation disorders. Second-ary postpartum hemorrhage may be caused by uterine subinvolution, coagulopathies, and abnormalities of the uterine vasculature. Extra-uterine sources of bleeding include rectus sheath hematoma, direct arterial injuries, and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Severe postpartum hemorrhage is a life-threatening condition that is diagnosed on the basis of the find-ings from clinical examination, with or without ultrasonography. Com-puted tomography (CT) and magnetic resonance imaging are useful in the characterization of postpartum hemorrhage when medical treat-ment fails. Multidetector CT has an important role when intraabdom-inal bleeding is suspected and can be considered in cases of recurrent bleeding after embolization, as well as for the evaluation of postsurgi-cal complications. A proposed clinical and CT imaging algorithm for postpartum hemorrhage is presented. A multidisciplinary approach to postpartum hemorrhage is essential to optimize the role of diagnostic and interventional radiology in obstetric hemorrhage, to avoid hyster-ectomy and thus preserve fertility. © RSNA, 2012 • radiographics.rsna.org Utility of Multidetector CT in Severe Postpartum Hemorrhage 1 Abbreviations: HELLP = hemolysis, elevated liver enzymes, and low platelet count, MIP = maximum intensity projection RadioGraphics 2012; 32:1463–1481 • Published online 10.1148/rg.325115113 • Content Codes: 1 From the CDI-Centre Diagnostic Per Imatge (A.S., M. Burrel, C.S., M. Barrufet, L.B., M.A.D., R.S., I.R.) and the