(693) Abdominal-Pelvic CT For Postpartum Maternal Infectious Morbidities: Clinical Utility and Predictive Factors for Intervention

To determine the yield of abdominal-pelvic computed tomography (CT) in the management of postpartum infectious complications unresponsive to empiric antibiotic therapy, and to identify maternal and labor characteristics associated with the need for interventional treatment.


Study Design:
This was a retrospective cohort study conducted at a single tertiary medical center between March 2011 and May 2025. 
We included postpartum patients who underwent abdominal-pelvic CT scans for unresolved postpartum infection. Per protocol, our clinical practice is to perform abdominal-pelvic CT scans for persistent postpartum fever and/or elevated inflammatory markers and/or presence of ultrasound findings suggesting intra-abdominal abscess.
Patients with missing delivery data were excluded. 
We compared clinical, laboratory, and radiological maternal characteristics between patients who required pelvic abscess drainage - via either surgical (laparoscopy or laparotomy) or CT-guided percutaneous intervention - and those managed conservatively.
 

Results:

During the study period there were 150,331 deliveries, 829 (0.55%) underwent abdominal-pelvic CT, of whom 713 (86%) met inclusion criteria. Pelvic drainage was required in 78 (10.9%) patients.

Patients who required pelvic drainage had a longer median duration of Cesarean delivery (CD) and of ruptured membranes, higher rates of CD- particularly unplanned, and higher rates of intra-operative use of hemostatic agents (Table 1). In the postpartum period they also experienced higher rate of fever, elevated inflammatory markers and pelvic abscess >5 cm compared with conservatively managed patients (Table 2).

 

Conclusion:

Abdominal-pelvic CT is a valuable diagnostic tool in the evaluation of postpartum infections unresponsive to empiric antibiotic treatment. Some clinical and laboratory features are associated with a higher likelihood of requiring interventional drainage and may aid in early identification of those individuals. Our findings supports the role of CT imaging in guiding timely and targeted postpartum management.