Learning objectives
-To illustrate and describe the main thrombotic complications during the postpartum period
- To review the imaging findings of the postpartum thrombotic complications
Background
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.1
A recent analysis placed pregnancy-related death rate at 14,5 deaths/100000 live births,
with more than three quarters happening during the postpartum period,
mostly associated with hemorrhagic or embolic complications.1
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...
Findings and procedure details
Pregnancy and puerperium are associated with an increased risk of thromboembolic events.
About 20% of these events are arterial,
and the other 80% are venous.
2
Venous thromboembolism
1.Deep venous Thrombosis and thrombophlebitis
Approximately 60–80% of venous thromboembolism cases that occur during pregnancy and puerperium correspond to deep venous thrombosis (DVT).2 One third of pregnancy-related DVT and half of pregnancy-related pulmonary emboli occur after delivery.3
It most commonly occurs in the lower limbs and represents a risk factor for pulmonary embolism.
There is left-sided predominance...
Conclusion
The hypercoagulability state that characterizes pregnancy and postpartum period has likely evolved to protect women from hemorrhage at the time of delivery or miscarriage.
In the developing world,
hemorrhage still represents the leading cause of maternal death.
However,
in developed countries,
where hemorrhage can be prevented and treated,
the most common cause of maternal death is thromboembolic disease.
Therefore,
it is essential for radiologists to be familiar with the main thrombotic complications that may present during this period.
References
1. 1.Plunk.
M; Lee.
J H; Kani,
K,; Dighe,
M.
“Imaging of the Postpartum Complications: A Multimodality Review”; AJR 2013; 200: W143-W154
2. 2.Himoto,
Y.
et all; “CT and MR imaging findings of systemic complications occurring during pregnancy and puerperal period,
adversely affected by natural changes”; Eur J Radiol Open.
2015; 2: 101–110
3. 3.Andra H.
James; Venous Thromboembolism in Pregnancy; Arteriosclerosis,
Thrombosis,
and Vascular Biology.2009;29:326-331
4. 4.Scarsbrook,
A.
F.,
Evans,
A.
L.,
Owen,
A.
R.,
& Gleeson,
F.
V.
(2006).
Diagnosis of suspected venous...