Table 3.

Differential diagnosis of postpartum hypotension using the ROSE scan (adapted from Dennis and Stenson).¹³ *Sepsis without myocardial depression

	Obstetric haemorrhage	Myocardial infarction	Cardiac failure	Disease sepsis*	Pulmonary embolism	Aortic dissection	Other
Clinical symptoms and signs	Hypotension, tachycardia, diaphoresis, evidence of blood loss—decreasing haemoglobin concentration	Hypotension, chest pain, ischaemic ECG changes, arrhythmias	Hypotension, tachypnoea, tachycardia	Hypotension, fever, tachycardia	Hypotension, pleuritic chest pain, tachypnoea, ECG changes	Hypotension, chest pain, interscapular pain	Consider trauma; pericardial effusion with tamponade; tension pneumothorax
PLAX and PSAX end-diastolic diameter	Reduced LVEDD	Normal LVEDD	Increased LVEDD	Normal LVEDD	Increased RVEDD
A4C ventricular volumes	Reduced LV and RV volumes	Normal LV and RV volumes	Increased LV and RV volumes	Normal LV and RV volumes	Increased RV size compared with LV
A4C contractility	Normal or increased LV and RV contractility	Reduced LV contractility, RWMA	Reduced LV and RV contractility	Increased LV and RV contractility	Normal, reduced or increased RV function
Haemodynamic cause of hypotension	Reduced preload	Reduced contractility, arrhythmia	Reduced contractility	Vasodilatation	Right heart failure

A4C, apical four-chamber view; LV, left ventricle; LVEDD, left ventricular end-diastolic diameter; PLAX, parasternal long-axis; PSAX, parasternal short-axis; RV, right ventricle; RVEDD, right ventricular end-diastolic diameter; RWMA, regional wall motion abnormality.