US Pelvis Transvaginal A combined transabdominal and transvaginal approach is the primary modality of choice for the investigation of early PPH not responsive to initial conservative measures. Although transvaginal US detection of an echogenic endometrial mass has the highest sensitivity for the detection of RPOC, this is a nonspecific finding that overlaps with the normal postpartum appearance [14]. The most diagnostic combination of US findings is an echogenic endometrial mass that is vascular [27]. The presence of debris and gas is relatively common in the early postpartum period, in as much as 20% to 25%. Thickened endometrial echo complex, up to 2 to 2.5 cm in diameter, is nonspecific in this early postpartum period [28]. Postpartum Hemorrhage US can detect most pelvic hematomas [13-15]. Rarely, US may demonstrate ovarian vein thrombosis as an echogenic mass within an enlarged ovarian vein [14]. Variant 3: Postpartum hemorrhage. Late (greater than 24 hours to 6 weeks) after caesarian delivery. Initial imaging. Secondary or late PPH is typically defined as any significant uterine hemorrhage occurring between 24 hours to 6 weeks postpartum. The most common etiologies are RPOC, subinvolution of the placental bed, or infection. RPOCs are more likely after vaginal delivery, whereas postpartum endometritis is more common after cesarean. Less common causes include, but are not limited to, coagulopathy, pseudoaneurysm or AVMs, dehiscent cesarean scar, or gestational trophoblast disease (GTD). Primary PPH is considered a risk factor for secondary PPH. CT Abdomen and Pelvis In the setting of hemorrhage, the primary role of CT is to determine whether active ongoing hemorrhage is present, to localize the bleeding, and to identify the source, which is best accomplished with a CT with IV contrast. There is little clinical utility in a noncontrast CT or CT with and without IV contrast in the setting of active ongoing hemorrhage.
Postpartum Hemorrhage. US Pelvis Transvaginal A combined transabdominal and transvaginal approach is the primary modality of choice for the investigation of early PPH not responsive to initial conservative measures. Although transvaginal US detection of an echogenic endometrial mass has the highest sensitivity for the detection of RPOC, this is a nonspecific finding that overlaps with the normal postpartum appearance [14]. The most diagnostic combination of US findings is an echogenic endometrial mass that is vascular [27]. The presence of debris and gas is relatively common in the early postpartum period, in as much as 20% to 25%. Thickened endometrial echo complex, up to 2 to 2.5 cm in diameter, is nonspecific in this early postpartum period [28]. Postpartum Hemorrhage US can detect most pelvic hematomas [13-15]. Rarely, US may demonstrate ovarian vein thrombosis as an echogenic mass within an enlarged ovarian vein [14]. Variant 3: Postpartum hemorrhage. Late (greater than 24 hours to 6 weeks) after caesarian delivery. Initial imaging. Secondary or late PPH is typically defined as any significant uterine hemorrhage occurring between 24 hours to 6 weeks postpartum. The most common etiologies are RPOC, subinvolution of the placental bed, or infection. RPOCs are more likely after vaginal delivery, whereas postpartum endometritis is more common after cesarean. Less common causes include, but are not limited to, coagulopathy, pseudoaneurysm or AVMs, dehiscent cesarean scar, or gestational trophoblast disease (GTD). Primary PPH is considered a risk factor for secondary PPH. CT Abdomen and Pelvis In the setting of hemorrhage, the primary role of CT is to determine whether active ongoing hemorrhage is present, to localize the bleeding, and to identify the source, which is best accomplished with a CT with IV contrast. There is little clinical utility in a noncontrast CT or CT with and without IV contrast in the setting of active ongoing hemorrhage.