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

M L Sanogo1, N Loudon1, T Talluri2

  • 1Department of Radiology, Division of Vascular and Interventional Radiology, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.

Clinical Radiology
|November 5, 2025
PubMed

Insights

A negative computed tomography angiography (CTA) effectively manages delayed postpartum hemorrhage (DPPH), with most patients resolving with conservative care. Positive CTAs accurately predict the need for transarterial embolization (TAE).

Area of Science:

  • Obstetrics and Gynecology
  • Vascular Imaging
  • Interventional Radiology

Background:

  • Delayed postpartum hemorrhage (DPPH) is a significant obstetric complication.
  • Computed tomography angiography (CTA) is increasingly used for diagnosing the cause of DPPH.
  • The role of a negative CTA in guiding management requires further evaluation.

Purpose of the Study:

  • To assess the utility of a negative computed tomography angiography (CTA) in the management of delayed postpartum hemorrhage (DPPH).
  • To determine the clinical outcomes and need for intervention in DPPH patients with negative CTA findings.

Main Methods:

  • Retrospective review of 23 patients with DPPH who underwent CTA between 2000 and 2023.
  • Identification of patients with negative CTA results.
  • Assessment of clinical outcomes, including resolution rates and adverse events, guided by Society of Interventional Radiology (SIR) guidelines.

Main Results:

  • Of 23 patients, 65.2% (15/23) had negative CTAs and 93.3% (14/15) resolved with conservative management.
  • Positive CTAs (34.8%, 8/23) accurately predicted active bleeding, leading to successful transarterial embolization (TAE).
  • One patient with a negative CTA experienced recurrent bleeding and was successfully treated for a uterine pseudoaneurysm.

Conclusions:

  • A negative CTA is a reliable indicator for conservative management in DPPH, obviating the need for transarterial embolization in most cases.
  • Positive CTAs correlate strongly with active hemorrhage requiring interventional treatment.
  • CTA plays a crucial role in the diagnostic and management pathway for delayed postpartum hemorrhage.
Abstract

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