Prediction of Positive Angiogram Using Enhanced Computed Tomography in Postpartum Hemorrhage: A Retrospective...

This study aimed to determine the accuracy of active arterial hemorrhage (AAH) on computed tomography (CT) in predicting the need for embolization in postpartum hemorrhage (PPH).

In a multicentered retrospective observational study, we reviewed the medical records of PPH patients between April 2010 and May 2020. We included patients who initially underwent enhanced CT and were subsequently classified as AAH+ or AAH- on CT. AAH+ on angiogram and embolization was used as a positive reference standard. A multiple logistic regression model evaluated AAH on CT as a predictor for embolization. We assessed AAH+ on CT supplied by extrauterine arteries.

Of 231 PPH patients, 94 underwent enhanced CT. AAH+ and AAH- on CT consisted of 44 and 50 patients, respectively. Of AAH+ on CT patients, 32 (72.7%) underwent angiography and embolization. The sensitivity, specificity, and positive and negative predictive values of AAH on CT were 95.6%, 69.0%, 50.0%, and 98.0%, respectively. A multiple logistic regression model revealed that AAH on CT was an independent predictor of embolization (odds ratio=9.31, confidence interval=2.85-30.50, p<0.01). Sites of AAH on CT were the vagina (n=7), intraperitoneal (n=3), and abdominal wall (n=3), except for intrauterine sites.

Enhanced CT showed high sensitivity and had a negative predictive value for predicting AAH+ on angiogram and embolization; this may be useful in ruling out the necessity for angiography. Active arterial hemorrhage on CT may predict embolization and identify the precise bleeding site.