E1704. A Case-Based Approach to Complications of Post-Partum Period
  1. Daniela Barros ; Hospital de Braga
  2. Filipa Costeira; Hospital de Braga
  3. Fernanda Gomes; Hospital de Braga
  4. Ana Costa; Hospital de Braga
  5. Catarina Costa; Hospital de Braga
The postpartum is defined as the period of 6 to 8 weeks immediately after the delivery of the infant and placenta. During this period, the physiologic changes of pregnancy slowly revert. During the last trimester of pregnancy and the first weeks postpartum there is a rise in the thrombotic risk, leading to an increase in morbidity and mortality during this period. In addition to hemorrhagic or embolic conditions, other complications such as endometritis and retained products of conception (RPOC) are relatively common after birth.

Educational Goals / Teaching Points
To describe the normal changes of the early postpartum period and to review the different entities and the imaging findings of the main complications during the postpartum period.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Nonthrombotic complications of the postpartum period include RPOC, postpartum hemorrhage, endometritis, postpartum infection and cesarean scar implatation or ectopic pregnancy. Common thrombotic complications include venous thromboembolism (deep venous thrombosis and thrombophlebitis, pulmonary embolism and ovarian vein thrombosis) and arterial thromboembolism like ischemic stroke. Imaging is often used as a complement to clinical history and physical examination in women with complications in the postpartum. Although ultrasound (US) is often performed in this period, imaging the postpartum uterus is not easy. It has a variable appearance and there is significant overlap between the normal and abnormal uterus. The most common indication for the use of ionizing radiation is the clinical suspicion of pulmonary embolism. In this situation, the benefits of definitive diagnosis and correct treatment outweigh the potential risks of radiation exposure.

The significant overlap between the physiologic and pathological changes of the postpartum uterus makes interpretation of US difficult during the postpartum period. It is of prime importance for radiologists to understand the pathophysiology underlying postpartum thrombotic and nonthrombotic complications, to be aware of the strengths and limitations of the various imaging modalities and the associated imaging findings.