Post-Partum Uterus Evaluation

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  • 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


  • 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