Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever: impact on management*

Michal Fishel Bartal*, Baha M. Sibai, Tali Ben-Mayor Bashi, Ayelet Dangot, Irit Schushan Eisen, Mordechai Dulitzki, Yael Inbar, Shali Mazaki-Tovi, Israel Hendler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use. Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation. Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7%) met inclusion criteria, 94 (39.5%) had a normal CT scan, and 144 (60.5%) had abnormal findings including 32 (13.4%) cases with pelvic thrombophlebitis and 112 (47%) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn’t find any significant risk factors associated with treatment change following the CT scan. Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.

Original languageEnglish
Pages (from-to)577-582
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume33
Issue number4
DOIs
StatePublished - 16 Feb 2020

Keywords

  • Postpartum fever
  • computerized tomography
  • endometritis
  • septic pelvic thrombophlebitis

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