Endometritis is a clinical diagnosis with a nonspecific CT appearance of a thickened heterogeneous endometrium with fluid, gas, and debris within the cavity [15]. Postpartum Hemorrhage CT can detect vascular complications such as supraumbilical and perivaginal space hematoma and delineate the relationship to adjacent organs (supralevator versus infralevator location in the perivaginal space) for targeted intervention [12,14,15,30]. CTA Abdomen and Pelvis Persistent hemorrhage after empiric embolization is an indication for CTA [12]. Active extravasation is seen in 41% to 74% cases of PPH on CTA [17] and multiphasic CT, including a noncontrast, arterial, and portal venous phases, has excellent accuracy of 97% [18] for detection of the site of active extravasation, similar to that of gastrointestinal hemorrhage [17,18]. CTA can be falsely positive because of dilated tortuous hypertrophic uterine arteries mimicking extravasation and be falsely negative in atony because of slow intermittent hemorrhage [12,18]. Serpiginous myometrial vessels and prominent parametrial vessels can be a sign of VUA [19], whereas the presence of a pseudoaneurysmal sac is a more specific finding [14,20,21]. CTA can also identify and localize the feeding arteries of AVM for treatment planning [14]. However, CTA cannot reliably distinguish acquired VUA from failure of obliteration or subinvolution of the placental bed vessels, assess its severity, or need for intervention [19]. MRI Pelvis MRI is not as commonly used in significant life-threatening early PPH as CT, in part related to access and to time required to perform the study in an acute setting. MRI has an important role to play in distinguishing and/or confirming uterine dehiscence versus rupture, in particular when it is confusing on US or CT. RPOC can be seen as a variably enhancing intracavitory mass with variable degree of myometrial thinning [13,14].
Postpartum Hemorrhage. Endometritis is a clinical diagnosis with a nonspecific CT appearance of a thickened heterogeneous endometrium with fluid, gas, and debris within the cavity [15]. Postpartum Hemorrhage CT can detect vascular complications such as supraumbilical and perivaginal space hematoma and delineate the relationship to adjacent organs (supralevator versus infralevator location in the perivaginal space) for targeted intervention [12,14,15,30]. CTA Abdomen and Pelvis Persistent hemorrhage after empiric embolization is an indication for CTA [12]. Active extravasation is seen in 41% to 74% cases of PPH on CTA [17] and multiphasic CT, including a noncontrast, arterial, and portal venous phases, has excellent accuracy of 97% [18] for detection of the site of active extravasation, similar to that of gastrointestinal hemorrhage [17,18]. CTA can be falsely positive because of dilated tortuous hypertrophic uterine arteries mimicking extravasation and be falsely negative in atony because of slow intermittent hemorrhage [12,18]. Serpiginous myometrial vessels and prominent parametrial vessels can be a sign of VUA [19], whereas the presence of a pseudoaneurysmal sac is a more specific finding [14,20,21]. CTA can also identify and localize the feeding arteries of AVM for treatment planning [14]. However, CTA cannot reliably distinguish acquired VUA from failure of obliteration or subinvolution of the placental bed vessels, assess its severity, or need for intervention [19]. MRI Pelvis MRI is not as commonly used in significant life-threatening early PPH as CT, in part related to access and to time required to perform the study in an acute setting. MRI has an important role to play in distinguishing and/or confirming uterine dehiscence versus rupture, in particular when it is confusing on US or CT. RPOC can be seen as a variably enhancing intracavitory mass with variable degree of myometrial thinning [13,14].