The diagnosis of postcesarean delivery complications with imaging techniques (ultrasound, computed tomography, magnetic resonance imaging, X-ray, and angiography).

Abstract

Cesarean delivery, one of the most common surgeries performed worldwide, carries the risk of complications. These complications affect both mothers and newborns, but in this review, only maternal complications will be addressed. Clinical signs and laboratory tests may raise suspicion of complications, but often diagnostic imaging is required for clarification and management planning. Imaging may be required for complications that occur in the immediate postpartum, delayed or late postpartum periods, and may impact short-term and long-term care, including subsequent pregnancies. In this manuscript, we review complications including: postoperative ileus, postpartum hemorrhage, urological injuries, surgical site infections, venous thromboembolism and septic pelvic thrombophlebitis, abnormal wound healing, uterine dehiscence or rupture, placenta previa and placenta accreta spectrum, cesarean scar ectopic pregnancy, retained products of conception, endometriosis, and adhesions. In most cases, the initial diagnosis is established on ultrasound which is the first-line imaging modality. However, in a fair number of cases, ultrasound is insufficient, and an alternate imaging modality is required, such as magnetic resonance imaging and computed tomography (for acute conditions). Interventional radiology is unique, as it may be used as both a diagnostic and therapeutic method in selected cases, such as severe postpartum hemorrhage. This expert review synthesizes information on the possible complications of cesarean delivery, pointing out the benefits of a precise diagnosis by the various modalities, with an emphasis on magnetic resonance imaging as the often-definitive noninvasive method of establishing the diagnosis. It serves up rich iconography illustrating the complications.