Impact of Contrast-Enhanced Computed Tomography on the Management of Postpartum Hemorrhage with Extravasation

Background: This study aimed to investigate the association of contrast extravasation (EV) detected on contrast-enhanced computed tomography (CE-CT) with the clinical characteristics, management, and outcomes of patients with postpartum hemorrhage (PPH). Methods: We retrospectively analyzed 51 patients with PPH who underwent CE-CT between August 2013 and July 2024. Patients were classified into EV (-) group (n = 28) and EV (+) group (n = 23). Baseline characteristics, management strategies, and clinical outcomes were compared. Results: The proportion of patients with a shock index (SI) ≥ 1.0 was significantly higher in the EV (+) group (10.7% vs. 39.1%, p = 0.017). Surgical intervention was more frequently required in the EV (+) group (10.7% vs. 56.5%, p = 0.001), whereas conservative management alone was more frequently successful in the EV (-) group (89.3% vs. 43.5%, p = 0.001). The EV (+) group showed higher rates of massive blood loss (> 2000 mL, 3.6% vs. 34.8%, p = 0.009), longer hospital stays (4.61 ± 2.61 vs. 6.88 ± 3.78 days, p = 0.034), and more frequent intensive care unit (ICU) admission (10.7% vs. 34.8%, p = 0.039). Patients in the EV (+) group had higher transfusion requirements (p < 0.005) and increased rates of disseminated intravascular coagulation (7.1% vs. 30.4%, p = 0.032). Conclusions: The presence of EV on CE-CT in PPH was associated with more severe clinical features, including greater transfusion requirements, increased rates of surgical intervention, ICU admission, and disseminated intravascular coagulation (DIC). Additionally, a higher proportion of patients with EV had a shock index ≥ 1.0, indicating early hemodynamic compromise.