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

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). Method...

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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
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container_title The journal of obstetrics and gynaecology research
container_volume 46
creator Ogoyama, Manabu
Nakamura, Hiroyasu
Ugajin, Atsushi
Nagayama, Shiho
Suzuki, Hirotada
Takahashi, Hironori
Baba, Yosuke
Usui, Rie
Matsubara, Shigeki
Ohkuchi, Akihide
description 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
doi_str_mv 10.1111/jog.14174
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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 &lt;7.0 g/dL (62.5 vs 0%, [P &lt; 0.001]), shock index ≥1.0 (50 vs 9.4% [P = 0.020]), and need for transfusion (37.5 vs 0% [P = 0.006]). Abnormal color Doppler flows were observed in all patients with either EV and sac on dynamic CT. Conclusion Dynamic CT was useful for diagnosing UAP, and for evaluating critical conditions, in women with late PPH not complicated by retained products of conception.</description><identifier>ISSN: 1341-8076</identifier><identifier>EISSN: 1447-0756</identifier><identifier>DOI: 10.1111/jog.14174</identifier><identifier>PMID: 31953915</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Color ; Comparative studies ; Computed tomography ; dynamic computed tomography ; Embolization ; Extravasation ; Hemoglobin ; Hemorrhage ; Hysterectomy ; late post‐partum hemorrhage ; Pseudoaneurysm ; ultrasonography, uterine artery embolization ; Ultrasound ; Uterus</subject><ispartof>The journal of obstetrics and gynaecology research, 2020-02, Vol.46 (2), p.249-255</ispartof><rights>2020 Japan Society of Obstetrics and Gynecology</rights><rights>2020 Japan Society of Obstetrics and Gynecology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3374-cfff18cdcf59f398c3f2ca85c269d2cb5d1165ee5658c15cd47a03249e5dfbe23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31953915$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ogoyama, Manabu</creatorcontrib><creatorcontrib>Nakamura, Hiroyasu</creatorcontrib><creatorcontrib>Ugajin, Atsushi</creatorcontrib><creatorcontrib>Nagayama, Shiho</creatorcontrib><creatorcontrib>Suzuki, Hirotada</creatorcontrib><creatorcontrib>Takahashi, Hironori</creatorcontrib><creatorcontrib>Baba, Yosuke</creatorcontrib><creatorcontrib>Usui, Rie</creatorcontrib><creatorcontrib>Matsubara, Shigeki</creatorcontrib><creatorcontrib>Ohkuchi, Akihide</creatorcontrib><title>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</title><title>The journal of obstetrics and gynaecology research</title><addtitle>J Obstet Gynaecol Res</addtitle><description>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 &lt;7.0 g/dL (62.5 vs 0%, [P &lt; 0.001]), shock index ≥1.0 (50 vs 9.4% [P = 0.020]), and need for transfusion (37.5 vs 0% [P = 0.006]). Abnormal color Doppler flows were observed in all patients with either EV and sac on dynamic CT. Conclusion Dynamic CT was useful for diagnosing UAP, and for evaluating critical conditions, in women with late PPH not complicated by retained products of conception.</description><subject>Color</subject><subject>Comparative studies</subject><subject>Computed tomography</subject><subject>dynamic computed tomography</subject><subject>Embolization</subject><subject>Extravasation</subject><subject>Hemoglobin</subject><subject>Hemorrhage</subject><subject>Hysterectomy</subject><subject>late post‐partum hemorrhage</subject><subject>Pseudoaneurysm</subject><subject>ultrasonography, uterine artery embolization</subject><subject>Ultrasound</subject><subject>Uterus</subject><issn>1341-8076</issn><issn>1447-0756</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kc1u1DAUhS0EoqWw4AWQJTawSBvHcZwsUUULqFI3dB157OuMR7Ed_EOVHY_AS_EifRI8M4UFEnfhey199-jYB6HXpD4npS52fjonLeHtE3RK2pZXNWfd0zLTllR9zbsT9CLGXV0TPpD-OTqhZGB0IOwU_bqLoPPsIEbsNVarE9ZILL1dcgKFk7d-CmLZrlj7gJURk_PRuAkLpzB8F3MWaX8tdDAOsAhlWPESISsvHOSwRhuxcfjeWyinSVs8iwR48TE9_Pi5lI1s8RasD2ErJsDOp4OB2Uix97BZcYAkirrCS_Aqy3QwK72TsCTj3Uv0TIs5wqvHfoburj5-vfxU3dxef778cFNJSnlbSa016aWSmg2aDr2kupGiZ7LpBtXIDVOEdAyAdayXhEnVclHTph2AKb2Bhp6hd0fdYuNbhphGa6KEeS4P9TmOTfnwrmkazgv69h9053NwxV2hWE3aoed9od4fKRl8jAH0uARjRVhHUo_7bMvWNB6yLeybR8W8saD-kn_CLMDFEbg3M6z_Vxq_3F4fJX8DAma1xw</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Ogoyama, Manabu</creator><creator>Nakamura, Hiroyasu</creator><creator>Ugajin, Atsushi</creator><creator>Nagayama, Shiho</creator><creator>Suzuki, Hirotada</creator><creator>Takahashi, Hironori</creator><creator>Baba, Yosuke</creator><creator>Usui, Rie</creator><creator>Matsubara, Shigeki</creator><creator>Ohkuchi, Akihide</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>202002</creationdate><title>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</title><author>Ogoyama, Manabu ; Nakamura, Hiroyasu ; Ugajin, Atsushi ; Nagayama, Shiho ; Suzuki, Hirotada ; Takahashi, Hironori ; Baba, Yosuke ; Usui, Rie ; Matsubara, Shigeki ; Ohkuchi, Akihide</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3374-cfff18cdcf59f398c3f2ca85c269d2cb5d1165ee5658c15cd47a03249e5dfbe23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Color</topic><topic>Comparative studies</topic><topic>Computed tomography</topic><topic>dynamic computed tomography</topic><topic>Embolization</topic><topic>Extravasation</topic><topic>Hemoglobin</topic><topic>Hemorrhage</topic><topic>Hysterectomy</topic><topic>late post‐partum hemorrhage</topic><topic>Pseudoaneurysm</topic><topic>ultrasonography, uterine artery embolization</topic><topic>Ultrasound</topic><topic>Uterus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ogoyama, Manabu</creatorcontrib><creatorcontrib>Nakamura, Hiroyasu</creatorcontrib><creatorcontrib>Ugajin, Atsushi</creatorcontrib><creatorcontrib>Nagayama, Shiho</creatorcontrib><creatorcontrib>Suzuki, Hirotada</creatorcontrib><creatorcontrib>Takahashi, Hironori</creatorcontrib><creatorcontrib>Baba, Yosuke</creatorcontrib><creatorcontrib>Usui, Rie</creatorcontrib><creatorcontrib>Matsubara, Shigeki</creatorcontrib><creatorcontrib>Ohkuchi, Akihide</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of obstetrics and gynaecology research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ogoyama, Manabu</au><au>Nakamura, Hiroyasu</au><au>Ugajin, Atsushi</au><au>Nagayama, Shiho</au><au>Suzuki, Hirotada</au><au>Takahashi, Hironori</au><au>Baba, Yosuke</au><au>Usui, Rie</au><au>Matsubara, Shigeki</au><au>Ohkuchi, Akihide</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>The journal of obstetrics and gynaecology research</jtitle><addtitle>J Obstet Gynaecol Res</addtitle><date>2020-02</date><risdate>2020</risdate><volume>46</volume><issue>2</issue><spage>249</spage><epage>255</epage><pages>249-255</pages><issn>1341-8076</issn><eissn>1447-0756</eissn><abstract>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 &lt;7.0 g/dL (62.5 vs 0%, [P &lt; 0.001]), shock index ≥1.0 (50 vs 9.4% [P = 0.020]), and need for transfusion (37.5 vs 0% [P = 0.006]). Abnormal color Doppler flows were observed in all patients with either EV and sac on dynamic CT. Conclusion Dynamic CT was useful for diagnosing UAP, and for evaluating critical conditions, in women with late PPH not complicated by retained products of conception.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31953915</pmid><doi>10.1111/jog.14174</doi><tpages>7</tpages></addata></record>
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1447-0756
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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
title 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
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