Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography.
OBJECTIVE
Post-partum hemorrhage (PPH) is the leading cause of maternal mortality. Identification of the precise bleeding site is generally important to control hemorrhage, but such an approach has not been fully established in the context of PPH. We postulated that visualization of bleeding sites could aid treatment decisions in the management of PPH.


METHODS
We conducted a prospective review of 26 patients who underwent dynamic computed tomography (CT) for PPH.


RESULTS
A total of 17 cases presented with uterine bleeding, eight with vaginal hematomas, and one with hemoperitoneum. Overall, dynamic CT identified contrast media extravasation in the arterial phase in 12 of 26 (46.2%) cases: the upper (n = 4) and the lower uterine segment including the cervix (n = 2), subfascial space (n = 1) and vagina (n = 5). Identification of precise arterial bleeding sites using CT provided informative guidance about where to place balloons for intractable uterine bleeding, and how to manage hemoperitoneum and vaginal hematomas. In addition, dynamic CT revealed the existence of a subtype of uterine atony, which is characterized by focal active arterial bleeding in the upper uterine segment. Furthermore, negative contrast extravasation extracted cases of PPH that were well controlled without the need for surgical or radiological intervention. No patient required emergency hysterectomy to control PPH.


CONCLUSIONS
Dynamic CT has potential clinical utility in treatment decision-making for PPH.
Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan.
Yosuke
Y
Kawamura
Eiji
E
Kondoh
Junzo
J
Hamanishi
Kaoru
K
Kawasaki
Kohei
K
Fujita
Akihiko
A
Ueda
Akeo
A
Kawamura
Haruta
H
Mogami
Ikuo
I
Konishi
D021721:Balloon Occlusion; D003287:Contrast Media; D003663:Decision Trees; D003937:Diagnosis, Differential; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D006465:Hemoperitoneum / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D011247:Pregnancy; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D055357:Uterine Artery Embolization; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D014623:Vaginal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy
D003287:Contrast Media
dynamic contrast-enhanced computed tomography; intrauterine balloon tamponade; post-partum hemorrhage; treatment decision-making; uterine atony