New findings support dynamic CT use in treatment-resistant postpartum hemorrhage
New findings published in JAMA Network Open support the use of dynamic CT imaging in women with treatment-resistant postpartum hemorrhage (PPH).
If PPH goes unresolved, it can be deadly. The condition is the leading cause of maternal death, accounting for approximately 8% globally, even in developed regions.
PPH is typically diagnosed based on the volume of blood loss, though more severe cases cannot always be identified through this method alone. In recent years, contrast-enhanced imaging has emerged as a means to identify the source of uncontrolled bleeding, which can guide providers in appropriately managing the condition.
“At present, no globally standardized, reliable diagnostic method exists to identify PPH cases that fail to respond to conventional treatment,” Munekage Yamaguchi, MD, PhD, with the department of obstetrics and gynecology at Kumamoto University in Japan, and colleagues explained. “In prior studies, we identified a subset of patients with severe PPH exhibiting contrast extravasation into the uterine cavity on early-phase dynamic computed tomography scans, many of whom required surgical interventions. To describe this condition, we introduced the term PRACE (postpartum hemorrhage, resistance to treatment, and arterial contrast extravasation).”
Though the use of dynamic CT imaging in PPH management has picked up, the method is lacking in standardized diagnostic criteria and definitions, the authors noted.
To build on what initial studies have determined regarding PRACE, the team retrospectively reviewed over 300 PPH cases across 43 tertiary facilities throughout Japan. They sought to determine the association between PPH severity, CT use and treatment via uterine artery embolization (UAE).
Of the 352 cases studied, 205 involved the use of CT scans. PRACE was detected in 32.2% of these cases and was associated with significantly higher blood loss and UAE requirement. Out of all the cases studied, PRACE was the primary factor associated with the need for UAE.
“Our results demonstrate that PRACE is not merely a common occurrence but serves as a critical marker for severe PPH, evidenced by its associations with massive transfusion requirements, coagulopathy development, and the need for UAE.” the authors wrote. “These findings position PRACE as a central determinant in severe PPH management strategies.”
The group added that their findings challenge the assumption that PPH is owed to localized bleeding in the uterine cavity. They suggested that CT in severe PPH cases could identify the bleeding source with greater accuracy, leading to improved management and outcomes.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.