In hemodynamically stable patients, when conventional medical treatment has been unsuccessful in terminating hemorrhage, multiphasic CT can be useful in localizing the source of extravasation for targeted therapy [12,29], particularly in suspected intra-abdominal hemorrhage [12]. CT can detect vascular complications such as bladder flap, subfascial, or perivaginal space hematoma and delineate relationship to adjacent organs (supralevator versus infralevator location in the perivaginal space) [14,15]. Small (<4 cm) subfascial and bladder flap hematomas may not be clinically significant [15]. A >5 cm bladder flap hematoma should raise suspicion for uterine dehiscence, characterized by disruption of the endometrial and myometrial layers with an intact serosal layer [15,16]. Low correlation between clinical and radiologic findings of dehiscence have been noted, and it is important not to interpret hypodense edema at the cesarean incision site as dehiscence in the first postpartum week [15]. Presence of gas in the myometrial defect extending from the endometrium to the parametrial tissue along with hemoperitoneum are findings suggestive of uterine rupture [15]. RPOC can be difficult to differentiate from blood products even on multiphase CT [12]. Endometritis is a clinical diagnosis with a nonspecific CT appearance of a thickened heterogeneous endometrium with fluid, gas, and debris within the cavity [15]. Superimposed parametrial abscess or infected hematoma and other complications such as ovarian vein thrombosis [14,15] can be detected on CT. GTD (most commonly choriocarcinoma after third trimester delivery) is a rare cause of delayed PPH and appears as a heterogeneous hypervascular intrauterine mass, often with central necrosis, indistinguishable from RPOC, except in cases of invasion of adjacent organs or distant metastasis [14]. CTA Abdomen and Pelvis Persistent hemorrhage after empiric embolization is an indication for CTA [12].
Postpartum Hemorrhage. In hemodynamically stable patients, when conventional medical treatment has been unsuccessful in terminating hemorrhage, multiphasic CT can be useful in localizing the source of extravasation for targeted therapy [12,29], particularly in suspected intra-abdominal hemorrhage [12]. CT can detect vascular complications such as bladder flap, subfascial, or perivaginal space hematoma and delineate relationship to adjacent organs (supralevator versus infralevator location in the perivaginal space) [14,15]. Small (<4 cm) subfascial and bladder flap hematomas may not be clinically significant [15]. A >5 cm bladder flap hematoma should raise suspicion for uterine dehiscence, characterized by disruption of the endometrial and myometrial layers with an intact serosal layer [15,16]. Low correlation between clinical and radiologic findings of dehiscence have been noted, and it is important not to interpret hypodense edema at the cesarean incision site as dehiscence in the first postpartum week [15]. Presence of gas in the myometrial defect extending from the endometrium to the parametrial tissue along with hemoperitoneum are findings suggestive of uterine rupture [15]. RPOC can be difficult to differentiate from blood products even on multiphase CT [12]. Endometritis is a clinical diagnosis with a nonspecific CT appearance of a thickened heterogeneous endometrium with fluid, gas, and debris within the cavity [15]. Superimposed parametrial abscess or infected hematoma and other complications such as ovarian vein thrombosis [14,15] can be detected on CT. GTD (most commonly choriocarcinoma after third trimester delivery) is a rare cause of delayed PPH and appears as a heterogeneous hypervascular intrauterine mass, often with central necrosis, indistinguishable from RPOC, except in cases of invasion of adjacent organs or distant metastasis [14]. CTA Abdomen and Pelvis Persistent hemorrhage after empiric embolization is an indication for CTA [12].