Secondary Postpregnancy Hemorrhage: Guide for Diagnosis and Management.

IF 5.2 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiographics Pub Date : 2025-05-01 DOI:10.1148/rg.240098
Alyssa Kirsch, Lori Strachowski, Liina Poder, Spencer Behr, Vickie Feldstein, Joelle Harwin, Evan Lehrman, Joseph Rabban, Dorothy Shum, Sara Whetstone, Hailey Choi
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引用次数: 0

Abstract

Secondary postpregnancy hemorrhage (PPH) is increasing in incidence, especially in developed countries such as the United States. PPH occurs after 24 hours and up to 12 weeks in the postpregnancy period and may be associated with significant maternal morbidity. Common causes of secondary PPH are subinvolution of the placental site (SIPS) and retained or residual products of conception (RPOC). Other less common and rare causes include bleeding diathesis, endo(myo)metritis, gestational trophoblastic disease, and vascular anomalies such as congenital arteriovenous malformation (AVM), iatrogenic arteriovenous fistula, or pseudoaneurysm. A common finding encountered during imaging evaluation of secondary PPH is increased vascularity in the myometrium deep to an implantation site, termed enhanced myometrial vascularity (EMV). EMV typically represents the physiologic reversion of the uterus back to its prepregnancy state. The appearance of EMV varies from mild to marked and is also associated with SIPS and RPOC. Interpretation or reporting of EMV as an AVM or other rare uterine vascular anomaly may lead to unnecessary testing and overtreatment. The authors review placental physiology, describe the causes of secondary PPH and their imaging appearances, and present an algorithm to assist the radiologist in diagnosis of this important condition and management options. ©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Gomez in this issue.

继发性妊娠后出血:诊断和处理指南。
继发性妊娠后出血(PPH)的发病率正在上升,特别是在美国等发达国家。PPH发生在妊娠后24小时至12周,可能与显著的孕产妇发病率有关。继发性PPH的常见原因是胎盘部位(SIPS)和保留或残留的受孕产物(RPOC)。其他不太常见和罕见的原因包括出血、子宫内膜炎、妊娠滋养层疾病和血管异常,如先天性动静脉畸形(AVM)、医源性动静脉瘘或假性动脉瘤。继发性PPH影像学评估中常见的发现是植入部位深部肌层血管增强,称为肌层血管增强(EMV)。EMV通常代表子宫恢复到孕前状态的生理逆转。EMV的外观从轻微到明显不等,也与SIPS和RPOC有关。将EMV解释或报告为AVM或其他罕见的子宫血管异常可能导致不必要的检查和过度治疗。作者回顾了胎盘生理学,描述了继发性PPH的原因及其影像学表现,并提出了一种算法,以协助放射科医生诊断这一重要疾病和管理选择。©RSNA, 2025本文可获得补充材料。请参阅本期Gomez的特邀评论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Radiographics
Radiographics 医学-核医学
CiteScore
8.20
自引率
5.50%
发文量
224
审稿时长
4-8 weeks
期刊介绍: Launched by the Radiological Society of North America (RSNA) in 1981, RadioGraphics is one of the premier education journals in diagnostic radiology. Each bimonthly issue features 15–20 practice-focused articles spanning the full spectrum of radiologic subspecialties and addressing topics such as diagnostic imaging techniques, imaging features of a disease or group of diseases, radiologic-pathologic correlation, practice policy and quality initiatives, imaging physics, informatics, and lifelong learning. A special issue, a monograph focused on a single subspecialty or on a crossover topic of interest to multiple subspecialties, is published each October. Each issue offers more than a dozen opportunities to earn continuing medical education credits that qualify for AMA PRA Category 1 CreditTM and all online activities can be applied toward the ABR MOC Self-Assessment Requirement.
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