ACR Appropriateness Criteria® Postpartum Hemorrhage

Area of Science:

• Radiology and Imaging Science
• Obstetrics and Gynecology
• Medical Diagnostics

Background:

• Postpartum hemorrhage (PPH) is classified as primary (within 24 hours) or late (24 hours to 6 weeks).
• While clinical diagnosis is primary, imaging is crucial for identifying many PPH causes.
• Accurate PPH diagnosis impacts maternal health outcomes significantly.

Framework:

• The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for imaging in PPH.
• Guidelines are developed through extensive literature review and expert consensus methodologies (RAND/UCLA, GRADE).
• These criteria ensure standardized, appropriate use of diagnostic imaging for PPH.

Implementation:

• Pelvic ultrasound (transabdominal and transvaginal with Doppler) is the recommended initial imaging modality for PPH evaluation.
• Contrast-enhanced CT and CT angiography are utilized for active hemorrhage assessment, localization, and source identification.
• Expert opinion supplements evidence for equivocal cases, guiding imaging and treatment decisions.

Implications:

• Appropriate imaging utilization can lead to faster diagnosis and more effective management of PPH.
• Standardized guidelines improve the consistency and quality of care for postpartum hemorrhage.
• Enhanced diagnostic accuracy through imaging supports better clinical decision-making and patient outcomes.