Postpartum Ultrasound

Abstract

This article describes uterine and uterine cavity changes throughout the normal and pathological puerperium, as revealed by various ultrasound modalities. A gray scale ultrasound, color and pulsed Doppler ultrasound and 3D ultrasound were used. It is based on results of several prospective longitudinal studies, which were designed so that every woman was examined at six occasions during the puerperium, namely on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. The same design was used in all studies. The involution process of the uterus was assessed by measuring the anteroposterior diameter of the uterus and uterine cavity. Morphological findings were recorded. The influence on the involution process of parity, breastfeeding, maternal smoking and infant's birth weight were also evaluated. Besides conventional ultrasound, Doppler technology was used to study hemodynamic events occurring during the normal puerperium. The pulsatility (PI) and resistance (RI) indices in the uterine arteries were measured, and the presence or absence of early diastolic notches was recorded. A hypervascular area in myometrium was assessed by color and power Doppler. Normal involution process was also described by means of 3D ultrasound. The volume of the uterus and uterine cavity after normal vaginal delivery were measured using virtual organ computer-aided analysis (VOCAL) using six adjacent planes and a 30° rotation method. Reference values from uncomplicated puerperium were used when pathological conditions were studied.Results from these studies, which shed light on normal and pathological changes during the puerperium, are summarized in this chapter.

Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study

“…Understanding of normal view of the uterus during the entire period of puerperium helps practitioners to avoid unnecessary interventions for alleged retained products of conception (RPOC) or atonic uterus [6–8, 16]. During the normal puerperium period, the uterine involution is defined by the changing indices of the uterine size, the uterine cavity inserts, and the uterine artery flow [1–5, 15]. Until recently, there were no studies showing a view of the uterus immediately after childbirth.…”

“…Until recently, there were no studies showing a view of the uterus immediately after childbirth. Most of the studies publish the first ultrasound examination findings on the 1st, 2nd, and 3rd postpartum days [1, 4, 11–13], but there is not a single ultrasound study examining the uterus within the first two hours after delivery. The strengths of this study are as follows: the research, from the beginning to the end, was conducted by one person; the same person assisted the women under analysis during delivery; the first data are obtained from the earliest puerperium (within two hours after delivery); a detailed explanation of the differences observed between primiparous and multiparous women is provided.…”

“…The AP diameter was measured in two points: in the widest part of the longitudinal section and 5 cm below the uterine fundus (UF), perpendicular to the longitudinal uterine axis. As usual, in praxis, the measurements are performed in the widest (maximum) part of the uterus [3–5, 15–20]; however, some researchers suggest measuring 5 cm below the uterine fundus [1, 6–8]. This study compares both points of measurement in primiparous and multiparous patients.…”

“…A number of ultrasound studies focus on puerperium and describe the changes detected in the size, the shape, the position, and the texture of the uterus [1–5]. Most of them report on the normal involution period of 6 weeks following labour after normal or pathological delivery, without addressing the differences in parity [1–8]. There is still a shortage of studies describing the uterine ultrasound differences found in primiparous and multiparous patients after normal labour from the earliest puerperium until 8 weeks of postpartum period [9].…”

“…There is still a shortage of studies describing the uterine ultrasound differences found in primiparous and multiparous patients after normal labour from the earliest puerperium until 8 weeks of postpartum period [9]. Only a few studies include Doppler measurements of uterine arteries during the normal involution period, or the scope of the examination is very narrow [1, 3, 10–14]. A longitudinal sonographic study is the best way to explore the similarities and differences that are likely to occur in primiparous and multiparous patients during puerperium.…”