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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
Author(s) -
Ogoyama Manabu,
Nakamura Hiroyasu,
Ugajin Atsushi,
Nagayama Shiho,
Suzuki Hirotada,
Takahashi Hironori,
Baba Yosuke,
Usui Rie,
Matsubara Shigeki,
Ohkuchi Akihide
Publication year - 2020
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14174
Subject(s) - medicine , uterine artery , radiology , pseudoaneurysm , color doppler , shock (circulatory) , artery , surgery , aneurysm , pregnancy , gestation , ultrasonography , genetics , biology
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 <7.0 g/dL (62.5 vs 0%, [ P < 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.