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Barrios-López M, Sánchez-Bernal S, Julián Gómez E, Galante MJ, Herrán de la Gala D, González-Sánchez FJ, Fernández-Flórez A, Barba-Arce A, González-Carreró C. Postpartum obstetric complications: a guide for radiologists. Abdom Radiol (NY) 2024:10.1007/s00261-024-04445-y. [PMID: 39088017 DOI: 10.1007/s00261-024-04445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 08/02/2024]
Abstract
The puerperium refers to the 6-8 weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key.
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Affiliation(s)
- Marta Barrios-López
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain.
| | - Sara Sánchez-Bernal
- Department of Radiology, Hospital Clínico Universitario de Salamanca, P San Vicente 182, 37007, Salamanca, Spain
| | - Elena Julián Gómez
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - María José Galante
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Darío Herrán de la Gala
- Department of Radiology, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | | | - Alejandro Fernández-Flórez
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Ana Barba-Arce
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
| | - Carmen González-Carreró
- Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av Valdecilla S/N, 39008, Santander, Spain
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Pinto A, Giurazza F, Califano T, Rea G, Valente T, Niola R, Caranci F. Interventional radiology in gynecology and obstetric practice: Safety issues. Semin Ultrasound CT MR 2021; 42:104-112. [PMID: 33541584 PMCID: PMC7525270 DOI: 10.1053/j.sult.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interventional radiology is continuing to reshape current practice in many specialties of clinical care and the fields of gynecology and obstetrics are no exception. Imaging skills, clinical knowledge as well as vascular and non-vascular interventional technical ability, are essential to practice interventional radiology effectively. Patient safety is of paramount importance in interventional radiology as in all branches of medicine. Potential failures occur throughout successful procedures and are attributed to a spectrum of errors, including equipment unavailability, planning errors, and communication errors. These are mainly preventable by improved preprocedural planning and teamwork. Of all the targeted and effective actions that can be undertaken to reduce adverse events, the use of safety checklists might have a prominent role. The advantage of a safety checklist for interventional radiology is that it guarantees that human error in terms of forgetting key steps in patient preparation, intraprocedural care, and postoperative care are not forgotten.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Naples, Italy.
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Teresa Califano
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Ferdinando Caranci
- Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
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Uyeda JW, George E, Reinhold C, Akin EA, Ascher SM, Brook OR, Henrichsen TL, Henwood PC, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Wall DJ, Glanc P. ACR Appropriateness Criteria® Postpartum Hemorrhage. J Am Coll Radiol 2020; 17:S459-S471. [PMID: 33153557 DOI: 10.1016/j.jacr.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
Postpartum hemorrhage (PPH) can be categorized as primary or early if occurring in the first 24 hours after delivery, whereas late or delayed PPH occurs between 24 hours and 6 weeks. Most of the causes of PPH can be diagnosed clinically, but imaging plays an important role in the diagnosis of many causes of PPH. Pelvic ultrasound (transabdominal and transvaginal with Doppler) is the imaging modality of choice for the initial evaluation of PPH. Contrast-enhanced CT of the abdomen and pelvis and CT angiogram of the abdomen and pelvis may be appropriate to determine if active ongoing hemorrhage is present, to localize the bleeding, and to identify the source of bleeding. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Elizabeth George
- Research Author, University of California San Francisco, San Francisco, California
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Patricia C Henwood
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts; American College of Emergency Physicians
| | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Rheinboldt M, Delproposto Z. Sonography of placental abnormalities: a pictorial review. Emerg Radiol 2015; 22:401-8. [PMID: 25933509 DOI: 10.1007/s10140-015-1320-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Often overlooked during routine ultrasound evaluation of a normal pregnancy, the placenta forms the biologic interface between the mother and fetus and is critical to fetal growth and development. Malformations in development, positioning, and vascularity can have profound implications for both maternal and fetal well-being. As such, a judicious inspection of the placenta is warranted as an integral part of every screening or emergent prenatal ultrasound. Herein, we present a pictorial review of a variety of placental pathologic conditions including abnormalities in positioning, adherence, vascularity, and hemorrhage as well as potential peri-placental masses and gestational trophoblastic disease, all of which are readily encountered in a busy emergency radiology practice.
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Affiliation(s)
- Matt Rheinboldt
- Department of Emergency Radiology, Henry Ford Hospital, Detroit, MI, USA,
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