The postpartum ultrasound scan

Abstract

Ultrasound assessment of the postpartum uterus has a significant role to play in the evaluation of a large proportion of symptomatic puerperal women. Often the imaging modality of choice for excluding retained placental tissue, correct application of postpartum ultrasound could enable more accurate identification of women requiring surgical intervention, with consequent reduction in patient morbidity and clinical workload. This article aims to review the current understanding and application of ultrasound in the puerperium and evaluate the current evidence investigating the physiological and pathological findings of the postpartum uterus and its contents.

Keywords: Postpartum; puerperium; ultrasound appearances; uterus.

Figure 1.

Diagram depicting the uterus throughout an uncomplicated puerperium. (a) Days 1 to 3: The uterus is retroverted. The cavity appears as a white line in the upper segment, and the lower segment/cervical region is expanded with fluid and solid components. (b) Day 7: The uterus is axial. Copious fluid or mixed components are visible within the whole cavity. (c) Day 14: The uterus is anteverted and the cavity resembles the findings of those at day 7. (d) Days 28 to 56: The uterine size is much decreased. The cavity is empty and appears as a thin white line. Reprinted with permission from Dr Mulic-Lutvica (Ultrasonic evaluation of the uterus and uterine cavity after normal, vaginal delivery. Ultrasound Obstet Gynecol 2001; 18: 491–498).

Figure 2.

Echogenic mass within the endometrial cavity seen in the sagittal plane on transvaginal scan 6 weeks post vaginal delivery.

Figure 3.

Application of colour Doppler demonstrates trophoblastic blood flow to the region of the echogenic mass, aiding diagnosis of retained products of conception.

Figure 4.

Echogenic mass seen within the lower uterine segment in the sagittal plane on transvaginal scan performed in a symptomatic patient 8 weeks post vaginal delivery.

Figure 5.

Echogenic mass within the lower uterine segment in the same patient (Figure 4) as seen in the transverse plane on transvaginal scan.

Figure 6.

Application of colour Doppler demonstrates trophoblastic blood flow to the region of the echogenic mass in the transverse plane on transvaginal scan (as seen in Figure 5) aiding diagnosis of retained products of conception.

Figure 7.

Post caesarean section haematoma originating from the anterior uterine wall, posterior to the urinary bladder, seen in the sagittal plane on transvaginal scan 7 days post procedure.

Figure 8.

Colour Doppler shows a non-vascular mixed echogenicity haematoma originating from the anterior uterine wall, posterior to the urinary bladder (sagittal plane on transvaginal scan).

Figure 9.

Colour Doppler reveals localised, highly vascular AVMs within the myometrium identified on transvaginal scan (sagittal plane).

Figure 10.

Colour Doppler reveals localised, highly vascular AVMs within the myometrium identified on transvaginal scan (sagittal plane).