Ultrasound examination of the postpartum uterus: What is normal?

Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Journal of Maternal-Fetal and Neonatal Medicine (Impact Factor: 1.37). 02/2004; 15(2):95-9. DOI: 10.1080/14767050310001650798
Source: PubMed


To establish normal ultrasonographic findings for the postpartum uterus after vaginal delivery, and to characterize associated bleeding patterns.
Postpartum women were scanned by transabdominal ultrasound within 48 h after normal vaginal delivery. Uterine length, uterine width, endometrial stripe thickness and endometrial contents were evaluated by a single sonographer. Patients maintained a daily symptom diary for 6 weeks and were interviewed by telephone at 2 weeks. Statistical analysis was performed using chi2, Fisher's exact test, Student's t test and Pearson correlation.
Mean endometrial stripe thickness was 1.1 +/- 0.6 cm, mean uterine length was 16.1 +/- 1.7 cm and mean uterine width was 8.7 +/- 1.0 cm. Postpartum bleeding requiring more than four protective pads per day for > or =10 days was associated with a thicker endometrial stripe (1.5 +/- 0.7 cm vs. 0.9 +/- 0.4 cm, p = 0.006). However, no patients experienced postpartum bleeding complications requiring intervention. Of the 40 women evaluated, 16 had echogenic material in the uterine cavity (mean size 12.7 +/- 6.9 cm2). The presence of echogenic material was not associated with the amount or duration of bleeding.
Frequent postpartum ultrasonographic findings include a thickened endometrial stripe and echogenic material in the uterine cavity. The echogenic material commonly seen in the endometrial cavity of asymptomatic patients was not associated with the development of bleeding complications.

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    • "In general, the uterine cavity is thin during the first 3 days following uncomplicated vaginal delivery, probably due to the contractions of the myometrium [16]. However , some authors showed that echogenic material can be present within the uterine cavity in up to 40% of asymptomatic women 48 hours following vaginal delivery [13]. After cesarean section, Koskas et al. observed a heterogeneous mixed-echogenicity mass in the uterine cavity in one woman (3.3%) who had an uneventful outcome [19]. "
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