This contrast-enhanced CT is from a young G2P2 woman who just had a vaginal delivery. She had a previous C-section but elected for a vaginal birth after Cesarean (also called trial of labor after Cesarean). After a long labor, she delivered a healthy baby successfully, but subsequently had persistent bleeding and abdominal pain.
Challenge: What's the diagnosis?
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3 comments:
three ideas... 1) Incomplete placenta with persistent bleeding. inspection of the placenta would be useful
2) Uterine atonia, which is a very common cause of uterine bleeding
3) as the women has had a C section, the risk for uterine rupture is increased. the CT scan confirms this as the uterine wall is discontinued and blood is present in the pelvis. urgent hysterectomy is indicated, Mortalility can range from 50 to 70 % for manifest ruptures.
Not sure what I'm looking at, but guessing uterine atony, or retained placenta?
good guesses! it's pretty unusual to get a scan of this disease.
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Postpartum
The CT shows a noninvoluted uterus with a large discontinuity at the right posterolateral wall (blue arrow) representing uterine rupture. The red arrow signifies blood in the pelvis.
Source: LearningRadiology.
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