Intra-abdominal hemorrhage must be diagnosed and managed expeditiously in women with hemodynamic instability after Cesarean delivery. Our objective was to determine the amount of free intra-abdominal fluid normally present on ultrasound after Cesarean delivery, and whether intra-operative blood loss influences this measurement.METHODS:
Transabdominal ultrasound examinations were performed in the supine position 1 to 3 hours after Cesarean delivery. Free intra-abdominal fluid was measured using a 5-1 MHz phased array transducer. Vertical fluid pockets were combined for each subject using a 4-quadrant technique. Cases with intraoperative irrigation were excluded. Demographic and delivery data, including intra-operative blood loss, were collected and analyzed.RESULTS:
None of the 85 participants had intra-abdominal bleeding within 12 hours after Cesarean delivery. One woman had an intra-abdominal hematoma and hemodynamic instability one day after delivery. Nineteen women (22.4%) had free fluid on ultrasound, with a median combined fluid pocket of 1.4 cm (range between 0.5 and 3.4 cm). Twenty women (23.5%) had intra-operative blood loss more than 1,000 ml. Intra-operative blood loss did not differ between women with and without free fluid on ultrasound (968 ml vs. 900 ml).CONCLUSION:
Sonographic assessment for free fluid may be useful after cesarean delivery when intra-abdominal bleeding is suspected. Although a small amount of free fluid may be visualized in a minority of patients, a combined fluid pocket of more than 3 cm is uncommon, and requires further evaluation. This ongoing study will assess the inter-observer variability, and the diagnostic accuracy of this sonographic technique.