Post-Partum Uterus Evaluation
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Normal
- Enlarged uterus and endometrial thickness up to 2cm (limit decreases with increasing time since delivery)
- No color doppler flow in endometrium
- No intracavitary mass
- No complex fluid in uterine cavity
Endometritis:
- Mostly clinical dx
- Thickened, heterogeneous endometrium
- Intracavitary fluid
- Intracavitary air (but present in 21% of normals)
- Color doppler flow in endometrium
- Uterus can appear normal.
- Most common reason for post-partum fever
Retained Products of Conceptions: (RPOC)
- If endometrium <1 cm, RPOC unlikely.
- RPOC 45% thickened without flow
- RPOC > 90% with thickening and color flow
- If flow is in endometrium this is NOT AVM/AVF; call RPOc
- AVM/F have flow isolated to myometrium
Imaging overlap with endometritis and hemorrhage from uterine atony (atony usually directly postpartum, RPOC bleeding usually later) PPV: Positive predictive value
Ref: The Sonographic and Color Doppler Features of Retained Products of Conception
Imaging the Endometrium: Disease and Normal Variants