Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever: impact on management*

Michal Fishel Bartal, Bahaeddine M Sibai, Tali Ben-Mayor Bashi, Ayelet Dangot, Irit Schushan Eisen, Mordechai Dulitzki, Yael Inbar, Shali Mazaki-Tovi, Israel Hendler

Research output: Contribution to journalArticle

Abstract

Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use. Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation. Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7%) met inclusion criteria, 94 (39.5%) had a normal CT scan, and 144 (60.5%) had abnormal findings including 32 (13.4%) cases with pelvic thrombophlebitis and 112 (47%) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn’t find any significant risk factors associated with treatment change following the CT scan. Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.

LanguageEnglish
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Fever
Tomography
Thrombophlebitis
Low Molecular Weight Heparin
Ionizing Radiation
Tertiary Care Centers
Laparotomy
Postpartum Period
Drainage
Cohort Studies
Multivariate Analysis
Retrospective Studies
Anti-Bacterial Agents
Costs and Cost Analysis
Therapeutics

Keywords

  • computerized tomography
  • endometritis
  • Postpartum fever
  • septic pelvic thrombophlebitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Fishel Bartal, M., Sibai, B. M., Ben-Mayor Bashi, T., Dangot, A., Schushan Eisen, I., Dulitzki, M., ... Hendler, I. (Accepted/In press). Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever: impact on management*. Journal of Maternal-Fetal and Neonatal Medicine. https://doi.org/10.1080/14767058.2018.1497603

Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever : impact on management*. / Fishel Bartal, Michal; Sibai, Bahaeddine M; Ben-Mayor Bashi, Tali; Dangot, Ayelet; Schushan Eisen, Irit; Dulitzki, Mordechai; Inbar, Yael; Mazaki-Tovi, Shali; Hendler, Israel.

In: Journal of Maternal-Fetal and Neonatal Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Fishel Bartal, M, Sibai, BM, Ben-Mayor Bashi, T, Dangot, A, Schushan Eisen, I, Dulitzki, M, Inbar, Y, Mazaki-Tovi, S & Hendler, I 2018, 'Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever: impact on management*' Journal of Maternal-Fetal and Neonatal Medicine. https://doi.org/10.1080/14767058.2018.1497603
Fishel Bartal, Michal ; Sibai, Bahaeddine M ; Ben-Mayor Bashi, Tali ; Dangot, Ayelet ; Schushan Eisen, Irit ; Dulitzki, Mordechai ; Inbar, Yael ; Mazaki-Tovi, Shali ; Hendler, Israel. / Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever : impact on management*. In: Journal of Maternal-Fetal and Neonatal Medicine. 2018.
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abstract = "Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use. Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation. Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7{\%}) met inclusion criteria, 94 (39.5{\%}) had a normal CT scan, and 144 (60.5{\%}) had abnormal findings including 32 (13.4{\%}) cases with pelvic thrombophlebitis and 112 (47{\%}) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0{\%}) patients, including: switching antibiotics in 24 (10{\%}) patients, adding low molecular weight heparin for 28 (11.8{\%}) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2{\%}) patients. In the regression model, we didn’t find any significant risk factors associated with treatment change following the CT scan. Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.",
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