Clinical outcome following a negative computed tomography (CT) angiogram for delayed postpartum haemorrhage

The aim of this study was to evaluate the role of a negative computed tomography angiography (CTA) in the management of patients who present with delayed postpartum haemorrhage (DPPH).

A retrospective review of all patients with DPPH who underwent CTA evaluation from January 2000 to December 2023 was conducted. Patients with negative CTAs were identified. Clinical outcomes were assessed. Adverse events were classified according to the Society of Interventional Radiology (SIR) guidelines.

Twenty-three patients (mean age: 31 years [range: 23-41]) with DPPH underwent CTA evaluation. A total of 34.8% (8/23) of the CTAs depicted evidence of contrast extravasation and were subsequently evaluated with catheter angiography which was positive in all the cases. These patients were successfully treated with transarterial embolisation (TAE). A total of 65.2% (15/23) of patients had negative CTA. Of this group, 93.3% (14/15) DPPH patients with negative CTA resolved with conservative management. One patient had recurrent bleeding 22 days after a negative CTA and subsequently underwent catheter angiography revealing a left uterine pseudoaneurysm which was embolised. There were no adverse events.

A total of 93.3% of patients presenting with DPPH who had a negative CTA responded to conservative management without the need for TAE. All cases of positive CTA predicted positive findings on catheter angiography and were treated with transcatheter embolisation.