Identification of bleeding sites in patients with postpartum hemorrhage: MDCT compared with angiography.
OBJECTIVE
This study was designed to evaluate retrospectively the accuracy of MDCT in the identification of bleeding sites in patients with postpartum hemorrhage.


METHODS
Twenty-seven consecutively registered patients (mean age, 31.4 years; age range, 24-39 years) with postpartum hemorrhage underwent contrast-enhanced MDCT before embolization. CT images were reviewed independently by two radiologists who were blinded to the angiographic findings. Disagreements were resolved by consensus. The MDCT diagnosis of active bleeding was made when extravasation of contrast material was identified on contrast-enhanced CT scans. The location of bleeding was classified according to four anatomic regions: uterine body, cervix, vagina, and paragenital area. Each bleeding location was recorded on the right and left sides. Conventional angiography was used as the reference standard. The sensitivity, specificity, and accuracy of MDCT in the detection of hemorrhage were assessed. We also assessed the presence of additional CT abnormalities that might influence further treatment.


RESULTS
Extravasation of contrast material was depicted on MDCT scans in 24 of 27 patients. The overall location-based sensitivity, specificity, and accuracy of MDCT in the detection of bleeding were 100% (38/38), 96% (171/178), and 97% (209/216). Additional abnormalities detected on CT images included rectus sheath hematoma with contrast extravasation (n = 5), extraperitoneal hematoma (n = 6), gestational pancreatitis (n = 2), diffuse liver disease (n = 2), and abdominal compartment syndrome (n = 1).


CONCLUSIONS
MDCT may have a role in the detection and localization of postpartum hemorrhage and yield supplementary information on extrauterine abnormalities.
Lee
Nam Kyung
NK
Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea.
Kim
Suk
S
Kim
Chang Won
CW
Lee
Jun Woo
JW
Jeon
Ung Bae
UB
Suh
Dong Soo
DS
D000328:Adult; D000792:Angiography / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007472:Iohexol / Q000031:analogs & derivatives; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide