Fig. 2

Displacement of posterior vaginal wall by clot accumulation in the birth canal. Sagittal images from the late phase of dynamic CT scans in patients transported for the management of severe primary postpartum hemorrhage (PPH) (A–H). Cases A and C showed contrast extravasation, with Case A involving a rupture of the lower uterine segment and Cases C and H resulting from vaginal lacerations. The remaining cases were due to uterine atony. The posterior vaginal walls are indicated by yellow dashed lines, and the asterisk marks the most dorsal aspect of the vaginal canal and the posterior fornix. The posterior vaginal wall was displaced dorsally due to the accumulation of blood clots in the birth canal (A–G). The distances between the asterisks, which may indicate the degree of upper vaginal extension, were as follows: A: 7.0 cm, B: 7.0 cm, C: 4.7 cm, D: 4.2 cm, E: 3.7 cm, F: 3.3 cm, G: 3.3 cm, and H: 0.9 cm. The scale bar indicates 4.0 cm.