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 . 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 . 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 . "
[Show abstract][Hide abstract] ABSTRACT: To describe sonographic findings associated with retained placental tissue in patients with secondary postpartum hemorrhage, and to compare these findings with those of women with a normal puerperium.
This was a prospective observational study of 79 women with secondary postpartum hemorrhage. Ultrasound examinations were performed on the day the patients presented with clinical symptoms and were scheduled for postpartum days 1, 3, 7, 14, 28 and 56, continuing until uterine surgical evacuation was performed or until the bleeding stopped. The maximum anteroposterior (AP) diameters of the uterus and uterine cavity were measured and morphological findings in the cavity were recorded. The findings were compared with previously published results from a normal population.
The patients were divided into two groups. Group 1 (n = 18) underwent surgery and Group 2 (n = 61) was treated conservatively. Sonography revealed an echogenic mass in the uterine cavity in 17 patients from Group 1, and in 14 of these patients histology confirmed placental tissue. The AP diameter of the uterine cavity was above the 90(th) percentile in all but two of the 18 Group 1 patients. In 18 patients from Group 2 the cavity was empty and in 43 a mixed-echo pattern was found. The uterine cavity was wider compared with the controls, but the values largely overlapped.
This report supports the opinion that the sonographic finding of an echogenic mass in the uterine cavity in women with secondary postpartum hemorrhage is associated with retained placental tissue.
Full-text · Article · Sep 2006 · Ultrasound in Obstetrics and Gynecology
[Show abstract][Hide abstract] ABSTRACT: To assess the appearance of the post-partum uterus on transabdominal ultrasound, and to correlate these findings with maternal morbidity.
In a prospective observational study, 94 women were seen within 24 h of their delivery and assessed by transabdominal ultrasound. Volumetric data were calculated from measurements of intrauterine echogenic areas. All women were contacted for a telephone interview 1-4 months following their delivery to assess whether they had experienced morbidity associated with their delivery such as post-partum haemorrhage, pyrexia, prolonged hospital stay, follow-up investigations or surgical intervention.
Two areas of echogenic material were identified in the upper and lower segment of the post-partum uterus. These were assessed independently for dimensions and volumes. The upper segment area had an average thickness of 13.8 mm and an average volume of 35.6 cm(3) The lower segment/cervical area held considerably more material with an average volume of 54.8 cm(3). The mean duration of post-partum bleeding was 4.2 weeks. None of the recruited women required a blood transfusion. The average hospital stay was 4 days. Twenty-two (23%) of the participants experienced a febrile illness following delivery, and 19 (20%) were commenced on antibiotics. None of these parameters of post-partum morbidity were associated with the ultrasound findings.
In this study ultrasound evaluation in the immediate post-partum period revealed unexpectedly large volumes of echogenic material in the uterine cavity. However, such volumes of echogenic material were not associated with postnatal morbidity, and can probably be accepted as normal.
Full-text · Article · Sep 2006 · Australian and New Zealand Journal of Obstetrics and Gynaecology