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. KeywordsPostpartum, puerperium, ultrasound appearances, uterus Date received: 28 February 2016; accepted: 11 May 2016 BMUS members can earn 1 CPD point by reading this approved CPD article and successfully completing the online test. Please go to the members' area of the BMUS website (www.bmus.org) and log into the BMUS CPD system.

Case study of atonic internal postpartum haemorrhage following severe preeclampsia and caesarean section

“…13 A USG examination of the uterus can be used as an alternative as it allows to evaluate a number of postpartum complications, including internal bleeding. 14 Lousquy et al suggests that ultrasound is more effective for the detection of intrauterine blood accumulation or retained products of conception than manual palpation, and therefore should be integrated into the evaluation of women with a high risk of severe PPH. 15 It is also confirmed that ultrasonographic diagnosis of Couvelaire's uterus may be restricted, but however possible.…”

How to Reach the Best Ultrasound Performance in the Delivery Room

“…The main cause of postpartum hemorrhage is uterine atony, which can be identified by the loss of at least 500 ml of blood after vaginal delivery or 1000 ml after c-section, associated with the lack of the Pinnard security globe, which represents the uterus involution and can be diagnosed by physical exam, through palpation of the uterine height. 73 74 Through sonographic exam, the mean uterine length is 16.1 ± 1.7 cm, 75 while the maximum anterior-posterior uterine dimeter reported was 9.2 cm 76 ( Figure 5 ). Concerning endometrial evaluation, some studies have shown no correlation between the duration or amount of bleeding and the presence of echogenic material diagnosed by postpartum ultrasound.…”

The role of ultrasound in the diagnosis and management of postpartum hemorrhage

“…Further, there is still a lack of consensus in the available literature regarding the individual role in the process of uterine involution of factors such as parity, birth weight and breastfeeding (Figure 2). 8–11 …”

“…Further, there is still a lack of consensus in the available literature regarding the individual role in the process of uterine involution of factors such as parity, birth weight and breastfeeding (Figure 2). [8][9][10][11] Indeed, there are several studies on uterine size in the postpartum period but due to the objective of this review to focus in primary PPH, we will mainly refer to the work of Sokol et al 12 who conducted a prospective observational study on the uterine ultrasonographic findings occurring after uneventful vaginal deliveries. They endometrial stripe thickness was evaluated as well as the maximum uterine length and width from a transabdominal uterine sagittal plane obtained in 40 women within 48 h after delivery.…”