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Identification of Bleeding Sites in Patients With Postpartum Hemorrhage: MDCT Compared With Angiography

¹ Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-Gu, Busan 602-739, Korea.
² Department of Radiology, Yangsan Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Yangsan, Korea.
³ Department of Obstetrics and Gynecology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan, Korea.

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

MATERIALS AND 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).

CONCLUSION. MDCT may have a role in the detection and localization of postpartum hemorrhage and yield supplementary information on extrauterine abnormalities.

Keywords: angiography • CT • hemorrhage • pregnancy • uterus

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