Usefulness of dynamic computed tomography for diagnosing and evaluating uterine artery pseudoaneurysms in women with late post‐partum hemorrhage not complicated by retained products of conception

• Published in: The journal of obstetrics and gynaecology research 2020-02, Vol.46 (2), p.249-255
• Main Authors: Ogoyama, Manabu, Nakamura, Hiroyasu, Ugajin, Atsushi, Nagayama, Shiho, Suzuki, Hirotada, Takahashi, Hironori, Baba, Yosuke, Usui, Rie, Matsubara, Shigeki, Ohkuchi, Akihide
• Format: Article
• Language: English
• Subjects: Color; Comparative studies; Computed tomography; dynamic computed tomography; Embolization; Extravasation; Hemoglobin; Hemorrhage; Hysterectomy; late post‐partum hemorrhage; Pseudoaneurysm; ultrasonography, uterine artery embolization; Ultrasound; Uterus
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.14174

Aim We examined whether critical conditions, which were defined as having hemoglobin (Hb) less than 7.0 g/dL, shock index ≥1.0, or need for transfusion, were associated with the presence of extravasation (EV) on dynamic computed tomography (CT) in women with late post‐partum hemorrhage (PPH). Methods Forty post‐partum women with late PPH without evident retained products of conception performed dynamic CT. Two radiologists retrospectively evaluated dynamic CT, and determined the presence or absence of EV and a sac‐like structure within the uterine cavity with enhancement. Results Ultrasound images were available in 34/40 patients. Color Doppler flow in uterine cavity was evaluated in 33/34 (97%), and all women showed abnormal flow. Of 40 patients, dynamic CT revealed EV in 8 (20%), and a sac‐like structure in 30 (75%). Thus, we diagnosed these 38 (95%) as having uterine artery pseudoaneurysm (UAP). Uterine artery embolization was performed in 36/38 diagnosed as having UAP, and in 2/2 patients with an unknown cause of hemorrhage. The incidence rates of critical conditions were significantly increased in PPH women with than without EV on dynamic CT: Hb