Sonographic evaluation for intra‐abdominal hemorrhage after cesarean delivery

Abstract

Sonographic evaluation immediately after cesarean delivery is feasible in most patients and was overwhelmingly negative for intra-abdominal hemorrhage in a group of patients who did not require reoperation or unexpected blood transfusion.

Postpartum Hemorrhage Emergency Management Using Focused Assessment With Sonography For Obstetrics (FASO): A Case Report

“…Unlike in uterine atony, in which vaginal bleeding occurs massively as an early sign of hemorrhage, the intra-abdominal bleeding from a vessel after tubal ligation can initially go undetected. Therefore, the diagnosis is usually delayed, increasing the risk of severe complications when definitive surgical treatment is not prompt [6]. Additionally, the interventions to manage uterine atony do not have a long lasting effect if the bleeding is intra-abdominal, increasing the risk of coagulopathy due to undetected bleeding [10].…”

“…Currently, the use of FAST protocol in the emergency department allows the evaluation of intra-abdominal and pericardial bleeding caused by trauma. POCUS has the advantage of being inexpensive, repeatable, and rapid at the patient's bedside, with no exposure to radiation [6]. The modification of the technique for obstetrics patients (FASO examines the following anatomical areas: placenta and uterine cavity, bilateral hypochondria and the pouch of Douglas.…”

“…This approach may facilitate an early diagnosis and an appropriate management, helping to establish the etiology of the bleeding. FASO provides an examination of the uterine and abdominal cavities with a safe, imaging technology at the bedside [6].…”

FAST exam for the anesthesiologist

“…However, a clinician trained in abdominal ultrasound could detect postoperative abdominal hemorrhage in the PACU at the bedside, decreasing time to diagnosis and management either at the bedside or in the operating room (OR). While studies on this indication are lacking, Hoppenot et al demonstrated that FAST exams were feasible, especially in the right and LUQs, after a Cesarean section 38. He found that most stable postoperative Cesarean section patients were negative for intra-abdominal free fluid.…”

Incidence and outcome of primary postpartum hemorrhage at Zagazig University Hospitals

“…It can occur after vaginal or cesarean delivery, it is the most common cause of maternal morbidity and may be complicated by shock, renal failure, acute respiratory distress syndrome, coagulopathy, and Sheehan'S syndrome. Postpartum hemorrhage is one of the top five causes of maternal death in both developed and developing countries [7]  Local examination: Estimated blood loss, Quantify the amount of blood loss by collecting blood in graduated volumetric containers, using visual aids that correlate the size and appearance of blood on specific surfaces (eg, maternity pad), examination under anathesia(uterus, cervix, vagina, and pernieum), for trauma, for uterine atony retained placental tissues, Postcesarean, it may not be recognized when blood is retroperitoneal, confined to the uterine cavity after closure of the uterine incision, When compensated shock is present (normal blood pressure with increasing heart rate) at cesarean delivery, these sites should be actively evaluated, modified focused assessment with sonography for trauma (FAST) examination in the recovery room may show fluid in the upper abdomen suggestive of intraabdominal bleeding, but sensitivity is low In all cases, clinical signs suggestive of ongoing bleeding (tachycardia, falling blood pressure, expanding abdomen, change in level of consciousness) should overrule a negative ultrasound scan in determining further management [8].…”