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Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography.

AbstractAIM:
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.
CONCLUSION:
Dynamic CT has potential clinical utility in treatment decision-making for PPH.
AuthorsYosuke Kawamura, Eiji Kondoh, Junzo Hamanishi, Kaoru Kawasaki, Kohei Fujita, Akihiko Ueda, Akeo Kawamura, Haruta Mogami, Ikuo Konishi
JournalThe journal of obstetrics and gynaecology research (J Obstet Gynaecol Res) Vol. 40 Issue 1 Pg. 67-74 (Jan 2014) ISSN: 1447-0756 [Electronic] Australia
PMID23937115 (Publication Type: Journal Article)
Copyright© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.
Chemical References
  • Contrast Media
Topics
  • Balloon Occlusion
  • Contrast Media
  • Decision Trees
  • Diagnosis, Differential
  • Extravasation of Diagnostic and Therapeutic Materials (diagnostic imaging)
  • Female
  • Hematoma (diagnostic imaging, physiopathology, therapy)
  • Hemoperitoneum (diagnostic imaging, physiopathology, therapy)
  • Hospitals, University
  • Humans
  • Postpartum Hemorrhage (etiology, prevention & control)
  • Pregnancy
  • Prospective Studies
  • Tomography, X-Ray Computed
  • Uterine Artery Embolization
  • Uterine Hemorrhage (diagnostic imaging, physiopathology, therapy)
  • Vaginal Diseases (diagnostic imaging, physiopathology, therapy)

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