A Pictorial Review of PostPartum Complications
Number:28ESURABS0140
Type:Educational Electronic Presentation
Authors: Kate Carey, Michael Morgan, Evis Sala, Janette Smith, Helen Clare Addley, Sue Freeman
Keywords:
SECTIONS
Educational objective

 

 Teaching Points: 

-When assessing imaging of the post-partum pelvis it is key to think of the 3 distinct phases with specific complications related to each: Acute (6-12hours), Subacute (2-6weeks) and Chronic (up to 6months) 

-It is vital to obtain good clinical information prior to assessing imaging of the post-partum pelvis. The normal and abnormal puerperal uterus can have very similar appearances and thus can be hard to accurately characterise without a good clinical history. 

-Imaging allows evaluation of suspected post caesarean-section (C-section) complications. It is...

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Fig 1. CT abdomen and pelvis sagittal and axial images in a 24yo female 4 days post an emergency C-section. Normal appearance of the uterus post C-section. Hypertrophic uterus with a mildly dilated uterine cavity and small locules of air within.(red arrow) There is also a small volume of fluid in the pelvis.(white asterisk)
Fig 2. 40 yo female underwent US 3 months post partum for menorrhagia. A. Longitudinal TVUS of the uterus shows a focal hyperechoic area at the site of the caesarean section scar.(red arrow) Patient underwent further evaluation with MRI. B. Sagittal T2 weighted MRI demonstrated a well circumscribed intermediate T2 signal collection at the c-section site. Imaging features consistent with uterine dehiscence with blood products at the site of C-section scar. (white arrow) c. Further imaging was obtained 2 years later and sagittal T2 weighted imaging shows a focal area of high signal intensity at the level of the C-section scar with thin overlying myometrium MRI 3 months later shows focal area of high signal intensity at the level of the C-section scar with thin overlying myometrium consistent with a large C-section niche. (yellow arrow)
Topic Review

Acute phase (6-12 hours) 

In the puerperium period the uterus is hypertrophic, the uterine cavity is distended and there is increased uterine vascularity; typically tubular enhancing structures are seen in the myometrium. It is necessary for the radiologist to recognise the normal appearance of the postpartum uterus. The uterus can have a variable appearance in the puerperium and can often have overlapping imaging characteristics with the abnormal, therefore good clinical information will enable accurate imaging interpretation. The uterus typically returns to its normal non-gravid state 6-8 weeks postpartum. 

There is a broad spectrum of post-partum related complications which are influenced by the mode of delivery. Did the...

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Conclusions

Conclusion: 

Radiologists play an important role in recognising postpartum complications and differentiating them from normal puerperium changes in the pelvis. A familiarity of the typical appearance of the postpartum pelvis across a wide range of modalities can help us differentiate the normal physiological state from the pathophysiological state allowing us to establish the correct diagnosis and provide the appropriate treatment. 

 

 

References: 

1.Eisenkop SM, Richman R, Platt LD, Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol. 1982;60:591–6....

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