CT scan pattern predicts risk of severe postpartum hemorrhage

CT scan pattern predicts risk of severe PPH | Image Credit: © Gorodenkoff - © Gorodenkoff - stock.adobe.com.

Researchers from Kumamoto University have developed a method of predicting severe postpartum hemorrhage (PPH) risk in women through a distinctive CT imaging pattern.¹

Nearly 1 in 3 patients presented with the new finding of Postpartum hemorrhage, Resistance to treatment, and Arterial Contrast Extravasation (PRACE) in dynamic CT scans, which was significantly correlated with requiring emergency procedures, including uterine artery embolization (UAE). According to researchers, UAE risk was increased over 3-fold in patients with PRACE.

"PRACE is a game-changer in how we assess and respond to critical postpartum bleeding," said Eiji Kondoh, MD, professor at Kumamoto University. “By using dynamic CT imaging, we can now detect early signs of treatment-resistant bleeding and act swiftly to save lives.”

Assessing CT imaging patterns

The retrospective case-control study was conducted to evaluate the prevalence and attributes of PRACE.² Data about PPH cases in 2021 were obtained from 43 tertiary facilities. Participants included PPH patients transported to these centers.

Patients with placental abruption, placental previa, hematomas in the vaginal wall, vulva, or perineal area, uterine rupture, uterine inversion, intraperitoneal bleeding, or cervical laceration were excluded from the analysis. The prevalence and characteristics of PRACE, alongside risk factors and the need for UAE, were reported as primary outcomes.

Risk variables linked to minimum fibrinogen levels under 150 mg/dL were reported as secondary outcomes. Exposures included pregnancy history, maternal age, myoma or adenomyosis presence, method of conception, mode of delivery, gestational age at delivery, cause of PPH, amount of blood loss, hemoglobin level, and fibrinogen level.

Defining PRACE

Relevant data were extracted from medical records across each center. Three examiners, 2 of whom were obstetricians and 1 a radiologist, independently assessed CT images. Discrepancies in PRACE diagnosis were resolved through consensus among these examiners.

PRACE was identified by the presence of an early-phase contrast agent in the uterine cavity. Those without agent leakage into the uterine cavity or contrast staining of the residual placental tissue were considered non-PRACE.

There were 352 participants aged a median of 33 years included in the analysis, 60% of whom were primiparous, 37.9% conceived through in vitro fertilization, and 7.9% had fibroids or adenomyosis. Leading causes of PPH included atonic uterus and retained placental tissue, accounting for 73.3% and 26.7% of cases, respectively.

Clinical outcomes and PRACE prevalence

A median total blood loss of 2487 mL was reported, and 25.9% of cases had minimum fibrinogen levels below 150 mg/dL. Of patients, 77.3% received blood transfusions and 29.8% received UAE. CT scans were performed in 58.2% of patients, with 32.2% of these cases presenting with PRACE.

There were 180 CT scans included in the final analysis, with no significant differences in maternal background and mode of delivery between PRACE and non-PRACE cases. However, significantly increased blood loss was reported in PRACE group, with a median of 3455 mL vs 2500 mL in the non-PRACE group.

Rates of minimum fibrinogen levels under 150 mg/dL were also higher in PRACE patients vs non-PRACE patients, at 57.9% vs 23.3%, respectively. Additionally, fibrinogen was administered to 43.1% and 17.2%, respectively. Finally, UAE was performed in 86.2% and 28.7%, respectively.

Risk factors and future directions

Risk factors linked to UAE included minimum fibrinogen levels below 150 mg/dL and underlying causes of PPH. Risk factors linked to severe coagulopathy included maternal age of at least 35 years, cesarean delivery, and PPH types. PRACE was indicated as the primary risk factor for UAE.

These results indicated a significant association between PRACE presence on dynamic CT scans and severe PPH. Investigators concluded CT imaging should be considered essential for the diagnosis of severe PPH.

“Future prospective studies focusing on standardization of imaging protocols and their integration into clinical decision-making pathways will be crucial for optimizing maternal outcomes in severe PPH cases,” wrote investigators.

References

1. New CT-based indicator helps doctors predict life-threatening postpartum bleeding cases. Kumamoto University. August 20, 2025. Accessed August 26, 2025. https://www.eurekalert.org/news-releases/1095440.
2. Yamaguchi M, Sagara A, Nagayama Y, et al. Dynamic computed tomography findings as indicators of uterine artery embolization in postpartum hemorrhage. JAMA Netw Open. 2025;8(5):e2512209. doi:10.1001/jamanetworkopen.2025.12209