Post-Partum Uterus Evaluation

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

• http://edus.ucsf.edu/sites/edus.ucsf.edu/files/wysiwyg/Durfee%20Retained%20POC.pdf

Imaging the Endometrium: Disease and Normal Variants

• http://radiographics.rsna.org/content/21/6/1409.long