Multidisciplinary consultation may aid in optimal management protocols in this group of patients with VUAs, RPOC, and PPH. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Pelvic angiography has not been included in this document because the clinical utility of pelvic angiography has a very limited role as an isolated diagnostic imaging study. Pelvic angiography in the setting of PPH is primarily used to perform therapeutic interventions, which is not within the scope of this document. OR Discussion of Procedures by Variant Variant 1: Postpartum hemorrhage. Early (within first 24 hours) after cesarean delivery. Initial imaging. The most common cause of early PPH is related to uterine atony or lack of effective uterine contraction after delivery and is typically a clinical diagnosis in >75% of patients. It is initially treated by uterine massage and uterotonic drugs such as oxytocin, and the majority of patients respond well to these treatments. In the setting of cesarean section, because the abdomen is already open, surgical procedures to control intraoperative and immediate hemorrhage such as uterine or ovarian artery ligation or uterine compression sutures may be utilized.
Postpartum Hemorrhage. Multidisciplinary consultation may aid in optimal management protocols in this group of patients with VUAs, RPOC, and PPH. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and recons/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. Pelvic angiography has not been included in this document because the clinical utility of pelvic angiography has a very limited role as an isolated diagnostic imaging study. Pelvic angiography in the setting of PPH is primarily used to perform therapeutic interventions, which is not within the scope of this document. OR Discussion of Procedures by Variant Variant 1: Postpartum hemorrhage. Early (within first 24 hours) after cesarean delivery. Initial imaging. The most common cause of early PPH is related to uterine atony or lack of effective uterine contraction after delivery and is typically a clinical diagnosis in >75% of patients. It is initially treated by uterine massage and uterotonic drugs such as oxytocin, and the majority of patients respond well to these treatments. In the setting of cesarean section, because the abdomen is already open, surgical procedures to control intraoperative and immediate hemorrhage such as uterine or ovarian artery ligation or uterine compression sutures may be utilized.