Small hematomas may be asymptomatic. Large ones may present with lower abdominal pain, dysuria, anemia and fever if infected.
It is an uncommon complication of cesarean section, due to bleeding and uterine dehiscence, usually at the transverse lower uterine incision. It has also been reported with longitudinal incisions.
The hematoma presents as a heterogeneous solid region with a variable amount of fluid component. Presence of gas foci strongly suggests infected hematoma or an abscess. US is less useful in demonstrating the dehiscence.
May show slightly hyperattenuating fluid density in between the posterior wall of bladder and uterus, however, MRI is preferred over CT.
It has the ability to distinguish the blood products (see: aging blood on MRI) and abscess. Sagittal and axial images have been very useful in demonstrating transverse lower uterine and longitudinal incisional dehiscence respectively.
- 1. Baker ME, Bowie JD, Killam AP. Sonography of post-cesarean-section bladder-flap hematoma. AJR Am J Roentgenol. 1985;144 (4): 757-9. doi:10.2214/ajr.144.4.757 - Pubmed citation
- 2. Nagayama M, Watanabe Y, Okumura A et-al. Fast MR imaging in obstetrics. Radiographics. 2002;22 (3): 563-80. doi:10.1148/radiographics.22.3.g02ma03563 - Pubmed citation
- 3. Sierra A, Burrel M, Sebastia C et-al. Utility of multidetector CT in severe postpartum hemorrhage. Radiographics. 2012;32 (5): 1463-81. doi:10.1148/rg.325115113 - Pubmed citation