Imaging Suspected Cardiovascular Complications of the “Fourth Trimester”

The postpartum period has been called the “fourth trimester.” The physiological changes that occur during this period are similar to, but still differ from, those of pregnancy. In particular, the cardiovascular system undergoes marked changes, predisposing postpartum patients to a unique and rarely potentially fatal array of cardiovascular pathologies. Disorders include the relatively common conditions, such as pulmonary edema and pulmonary embolism, and the less common conditions, such as spontaneous coronary artery dissections and acute aortic pathologies. A thorough understanding and recognition of these pathologies in postpartum patients can allow for accurate diagnosis and appropriate imaging recommendations. The postpartum/peripartum period, which has recently been referred to as the fourth trimester, comprises a unique spectrum of physiological states that are similar to, but still differ from, those of pregnancy as well as from those of the nonpregnant state. Due to this, the fourth trimester not only shares many common conditions and potential complications with pregnancy, but also has its own unique set of potential complications. The purpose of this review article is to provide an overview of the imaging appearance of the more common, and not so common, clinical conditions associated with the postpartum period, as well as suggest appropriate diagnostic imaging algorithms and treatments. Focus will be placed on the cardiovascular system since it is the number one cause of maternal morbidity and mortality in the United States.