Secondary Postpregnancy Hemorrhage: Guide for Diagnosis and Management

Area of Science:

• Radiology
• Obstetrics & Gynecology
• Vascular Imaging

Background:

• Secondary postpartum hemorrhage (PPH) incidence is increasing, particularly in developed nations.
• Causes include subinvolution of placental site (SIPS), retained products of conception (RPOC), and rare vascular anomalies.
• Enhanced myometrial vascularity (EMV) is a common imaging finding in secondary PPH.

Purpose of the Study:

• To review placental physiology and causes of secondary PPH.
• To describe imaging appearances of secondary PPH causes, including EMV.
• To provide an algorithm for diagnosing secondary PPH and guiding management.

Main Methods:

• Review of placental physiology.
• Description of imaging findings for secondary PPH etiologies.
• Development of a diagnostic and management algorithm for radiologists.

Main Results:

• EMV is a frequent finding in secondary PPH, often representing normal postpartum uterine changes.
• EMV can be associated with SIPS and RPOC.
• Misinterpreting EMV as a rare vascular anomaly can lead to overtreatment.

Conclusions:

• Distinguishing EMV from rare uterine vascular anomalies is crucial for appropriate patient management.
• Radiologists require clear diagnostic criteria to avoid unnecessary interventions.
• The proposed algorithm aids in the accurate diagnosis and management of secondary PPH.