Maternal Assessment With Sonography for Hemorrhage (MASH): A Prospective Cohort Study [33P]

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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.


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.


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).


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.

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