Video image: Ultrasound findings of a novel subtype of atonic postpartum hemorrhage: is it still a diagnosis of exclusion?

Postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide.1) Blood transfusion is required in 4 to 5 cases per 1,000 deliveries in high resource countries.2) Uterine atony is a leading cause of PPH, and the use of intrauterine balloon tamponade (IBT) is recommended as the first-line surgical intervention for intractable atonic PPH. However, IBT fails to control uterine bleeding in roughly one-fifth of cases.3) We previously reported that intractable atonic PPH is invariably due to a serious subtype of PPH, termed “PRACE” (Postpartum hemorrhage, Resistance to treatment, and Arterial Contrast Extravasation on dynamic computed tomography (dCT) scans).4) Here we report that color Doppler ultrasonography can be a useful tool for diagnosing upper type of PRACE.