|ECR 2018 / C-1696|
|Thrombotic complications in the postpartum period|
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 and mortality during this period.
The risk of venous thromboembolism is five times higher in pregnant women than in non-pregnant and it represents the leading cause of maternal death in Western Countries. The rate of thromboembolism has been found to be the highest during the postpartum period and it requires four weeks for the risk to return to normal after delivery.2
The mechanism of this thrombophilia is thought to be due to an increase in fibrin and other coagulation factors levels, as well as an up-regulation of plasma prothrombotic mediators. Synergically, during the third trimester of pregnancy, there is a decrease in lower extremities venous velocities, leading to greater risk of deep vein thrombosis and pulmonary embolism.
The postpartum period is characterized by numerous and rapid physiological changes, many of which are poorly understood. Differentiating a normal post-partum physiological state from a pathological one may represent a clinical challenge.
Imaging is often used as a complement to clinical history and physical examination in women with complications in the postpartum.
During this period, concerns about fetal exposure to ionizing radiation are no longer present. Nevertheless, exposure of the lactating breast remains an important topic. Therefore breast radiation dose should be considered and indication for imaging should be carefully accessed.
The most common indication for the use of ionizing radiation in the post-partum period is the clinical suspicion of pulmonary embolism. In this situation, the benefits of definitive diagnosis and correct treatment outweigh the potential risks of radiation exposure.
When available and adjusted to the clinical suspicion, ultrasound evaluation should be preferred during this period and, if not conclusive, one should consider the use of magnetic resonance.
It is of prime importance for radiologists to understand the pathophysiology underlying postpartum thrombotic complications, to be aware of the strengths and limitations of the various imaging modalities and the associated imaging findings.
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