VUA can also be seen on MRI fast-spin echo sequence as serpiginous signal voids with prominent parametrial vessels, whereas the presence of a pseudoaneurysm sac is more specific [14,20]. Failure of obliteration of the placental bed vessels after pregnancy cannot be reliably distinguished from acquired VUA on MRI [19]. US Duplex Doppler Pelvis Transabdominal US is often performed in conjunction with transvaginal US and color or power Doppler and should be considered a single examination. Color and spectral Doppler are commonly employed in pelvic sonography to detect the presence of vascular flow in normal anatomic structures as well as various pathologic lesions. In women with PPH, Doppler improves the specificity and negative predictive value of detecting RPOC by detecting vascularity within a thickened endometrial echo complex [24]. When a pseudoaneurysm is suspected, color and spectral Doppler can detect swirling or yin-yang pattern of blood flow within a hypoanechoic structure [14,20]. Pitfalls in assessment include that absence of vascularity could represent an avascular RPOC [12] and marked vascularity can mimic a pseudoaneurysm, although RPOC generally extends to the endometrium, whereas pseudoaneurysm is restricted to the myometrium [25]. However, it can be difficult to distinguish acquired VUA from subinvolution of the placental bed [19,26] or to assess its severity or need for intervention on US [19]. Although high peak systolic velocities have been used to predict need for intervention, there is considerable overlap [7]. 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].
Postpartum Hemorrhage. VUA can also be seen on MRI fast-spin echo sequence as serpiginous signal voids with prominent parametrial vessels, whereas the presence of a pseudoaneurysm sac is more specific [14,20]. Failure of obliteration of the placental bed vessels after pregnancy cannot be reliably distinguished from acquired VUA on MRI [19]. US Duplex Doppler Pelvis Transabdominal US is often performed in conjunction with transvaginal US and color or power Doppler and should be considered a single examination. Color and spectral Doppler are commonly employed in pelvic sonography to detect the presence of vascular flow in normal anatomic structures as well as various pathologic lesions. In women with PPH, Doppler improves the specificity and negative predictive value of detecting RPOC by detecting vascularity within a thickened endometrial echo complex [24]. When a pseudoaneurysm is suspected, color and spectral Doppler can detect swirling or yin-yang pattern of blood flow within a hypoanechoic structure [14,20]. Pitfalls in assessment include that absence of vascularity could represent an avascular RPOC [12] and marked vascularity can mimic a pseudoaneurysm, although RPOC generally extends to the endometrium, whereas pseudoaneurysm is restricted to the myometrium [25]. However, it can be difficult to distinguish acquired VUA from subinvolution of the placental bed [19,26] or to assess its severity or need for intervention on US [19]. Although high peak systolic velocities have been used to predict need for intervention, there is considerable overlap [7]. 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].