Sonographic evaluation for intra-abdominal hemorrhage after cesarean delivery

Purpose: To evaluate whether intra-abdominal hemorrhage is visible on a modified focused assessment with sonography for trauma (FAST) examination in stable obstetrics patients after a nonemergent cesarean delivery. Methods: This was a prospective observational study of patients who underwent nonemergent cesarean delivery at a single institution. Patients provided written informed consent to participate in the study preoperatively and underwent a modified FAST examination in the recovery room within 2 hours of completion of surgery. A sonographic examination was considered positive for hemorrhage if an anechoic pocket consistent with free fluid was present. Results: One hundred patients underwent suprapubic and bilateral upper-quadrant sonographic evaluations. The mean (±SD) time of the evaluation was 74.2 ± 36 minutes after the end of surgery. Among the 100 sonographic examinations of each upper quadrant, 194 (97.0%) were negative, 5 (2.5%) were indeterminate, and 1 (0.5%) was positive for fluid. All suprapubic sonographic examinations were considered inadequate. Conclusions: Sonographic evaluation immediately after cesarean delivery is feasible in most patients and was overwhelmingly negative for intra-abdominal hemorrhage in a group of patients who did not require reoperation or unexpected blood transfusion.