Conflict of interest: The authors report no conflict of interest.
Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography
Article first published online: 12 AUG 2013
© 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology
Journal of Obstetrics and Gynaecology Research
Volume 40, Issue 1, pages 67–74, January 2014
How to Cite
Kawamura, Y., Kondoh, E., Hamanishi, J., Kawasaki, K., Fujita, K., Ueda, A., Kawamura, A., Mogami, H. and Konishi, I. (2014), Treatment decision-making for post-partum hemorrhage using dynamic contrast-enhanced computed tomography. Journal of Obstetrics and Gynaecology Research, 40: 67–74. doi: 10.1111/jog.12123
- Issue published online: 1 JAN 2014
- Article first published online: 12 AUG 2013
- Manuscript Accepted: 4 MAR 2013
- Manuscript Received: 31 OCT 2012
- dynamic contrast-enhanced computed tomography;
- intrauterine balloon tamponade;
- post-partum hemorrhage;
- treatment decision-making;
- uterine atony
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.
We conducted a prospective review of 26 patients who underwent dynamic computed tomography (CT) for PPH.
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.
Dynamic CT has potential clinical utility in treatment decision-making for PPH.