Outcomes of Image-Guided Percutaneous Drainage versus Other Management Strategies for Infected Post–Cesarean Section Bladder Flap Hematoma

Abstract

Purpose

To evaluate the safety and effectiveness of percutaneous drainage in the management of infected post–cesarean section (CS) bladder flap hematomas (BFHs).

Materials and Methods

This retrospective cohort study examined all post-CS imaging examinations performed between January 1, 1999, and April 1, 2022. Of 90,462 CSs performed, 255 patients underwent postpartum pelvic imaging. Images were assessed for BFH and features of infection. Infected BFH was defined by the presence of the systemic inflammatory response syndrome criteria for sepsis, with or without imaging features of infection. Data on treatment approach, outcomes, hospitalization duration, and readmission were obtained when available. The t-test was used for parametric data and Mann-Whitney U test was used for nonparametric data.

Results

BFH was diagnosed in 56 (22%) of 255 patients, with a median age of 31 years (interquartile range, 26.8–35.0 years). Forty-five (80%) of 56 patients presented with infection and were treated either with antibiotics alone (26/45, 58%) or drainage procedures (19/45, 42%) combined with antibiotics (surgical [3/19, 16%] and percutaneous drainage [16/19, 84%]). Percutaneous drainage had a success rate of 94% (15/16). Conservative management with antibiotics alone also had a high success rate of 96% (25/26); however, 1 (4%) of 26 developed uterine scar dehiscence. The median lengths of hospital stay were 4 days (range, 1–12 days) for the antibiotic-only group and 6 days (range, 3–39 days) for the drainage group (P < .01). Readmission within 30 days occurred in 7 (27%) of 26 patients in the antibiotic group compared with 3 (19%) of 16 in the drainage group.

Conclusions

Percutaneous image-guided drainage is safe and highly effective in managing infected BFHs that do not respond to antibiotics with no increased risk of uterine scar dehiscence.