PMC9130014_01
(a) Contrast-enhanced computed tomography images at the time of massive postpartum hemorrhage: extravasation from the uterine cavity ( ). (b) massive ascites.
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Contrast-enhanced computed tomography (CT) showed extravasation within the uterus, along with massive ascites (Figure 1).
(a, b) The images of the left uterine artery before and after embolization. The extravasation ( ) is no longer seen after embolization. The flow in the left uterine artery is preserved after embolization ( ). (c, d) The images of the right uterine artery before and after embolization. The extravasation is not detected in the right uterine artery. The flow in the right uterine artery is also preserved after embolization ( ).
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The flow from bilateral uterine arteries to the uterus was preserved after the embolization (Figure 2).
Chest radiograph at postpartum day 2 shows bilateral pleural effusion.
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Although UAE enabled hemostasis, ascites resulted in abdominal distention, and pulmonary edema deteriorated (Figure 3).
(a, b) Cross section of the internal myometrium in abdominal ultrasonography on postpartum day 24. Abdominal ultrasonography does not show blood flow in the internal myometrium by abdominal ultrasound. (c, d) MRI shows heterogeneous high intensity in internal myometrium on sagittal T2-weighted images (c) without contrast enhancement on sagittal postcontrast T1-weighted images (d), indicating necrosis.
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Magnetic resonance imaging (MRI) demonstrated a heterogeneous high-intensity area in the internal myometrium on T2-weighted images without contrast enhancement on postcontrast T1-weighted images (Figure 4).
(a) Laparoscopic images of the uterine surface during surgery. The uterine surface appeared normal. (b) Macroscopic finding of the resected uterus shows the inner myometrium of the uterus is necrotized ( ).
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Although the surface of the uterus appeared to be normal, the resected internal myometrium was reddish-black and malodorous (Figure 5).