Magnetic resonance imaging of postpartum pelvic hematomas: early experience in diagnosis and treatment planning.

The purpose of this study was to determine the utility of magnetic resonance imaging (MRI) in detecting and localizing clinically non-apparent postpartum pelvic hematomas, and to describe the therapeutic implications of MRI in these patients. MRI examinations were performed on seven women with pelvic pain and/or fullness following difficult vaginal deliveries. None had clinically evident hematomas, and none were scheduled for surgery. Hematomas in the pelvis were identified with conventional T1-weighted, and conventional and fast spin echo T2-weighted sequences. Intravenous contrast was not used. Pelvic hematomas were identified in contiguity with the vagina, cervix, and bladder, within the broad ligament, and in the presacral space. In two patients, hematomas were confined to the perivaginal and pericervical regions. In three patients, perivaginal hematomas extended between the double layers of the broad ligaments. In one patient, a perivaginal hematoma extended into the perivesical space. In one patient, a hematoma was identified only within the presacral space. Based on MRI as the only contributory imaging study, five patients were treated successfully with invasive means and two patients were managed successfully with conservative means. MRI successfully detects and localizes postpartum hematomas, information that often is unavailable from the clinical examination. This information facilitates decisions regarding the need for intervention and the appropriate type of procedure when intervention is necessary for this potentially life-threatening problem. We advocate the use of MRI to evaluate patients at risk for postpartum hemorrhage following difficult vaginal deliveries.