الفهرس 
Introduction
Normal PuerperiumOnly 14 pages are availabe for public view
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Abstract
A description of normal ultrasonic changes of the uterus in the puerperium is a prerequisite for ultrasound diagnosis of pathological conditions. This study was carried out with its main objective was to describe the ultrasonographic features of the uterus and uterine cavity within the first 24 hours following delivery and after 2 weeks of delivery, to evaluate the Doppler changes of the uterus and uterine arteries, and to correlate the ultrasonographic findings with postnatal maternal morbidities, if occurs.
The study was a prospective, descriptive, observational study; carried out with 363 consecutive parturients, examined clinically and ultrasonographically in the first postnatal day; of whom 108 women re-examined after 2 weeks of delivery and 89 women contacted by telephone interview. Two-dimensional ultrasound was done for all the cases to evaluate the morphological appearance of the uterus and uterine cavity, and to measure the uterine dimensions as well as of thickness of the endometrium. Uterine blood flow was recorded by Doppler sonography and vascular impedance was estimated. Furthermore, correlation between ultrasound findings and the presence of risk factor(s) and the appearance of puerperal morbidities were done.
After statistical analysis of the obtained data, it was found that in spite of great variations of the normal US appearance of the puerperal uterus some findings are characteristic of early and middle puerperium. In the early puerperium the cavity is empty. A mixed echo pattern fills the whole cavity in the middle part of the puerperium, even when the cavity was empty in the immediate puerperium, and is a common and insignificant finding of the healing uterus, and therefore should not interpret as pathologic.
The longitudinal diameter of the uterus (uterine length) and uterine volume decrease faster than the anteroposteior and transverse diameters. So, they are the best indicators of involution process.
Uterine involution delayed in the presence of risk factors, cesarean delivery, multiparity and in the small sized uterus of preterm birth.
Regarding Doppler US, EMV found in 11.3% of our study population, regardless of the presence of risk factors; and these areas resolved spontaneously in most cases scanned 2 weeks later. So, it reflects intermediate stages in the involution of the placental bed.
EDN observed in 36.4% of the women on postnatal day one. Uterine artery PI and RI are higher than those reported in late pregnancy, which indicate significant increase in the vascular impedance of uterine arteries after delivery. No significant increase was seen in the postpartum day 14.
Postpartum complications involving the uterus encountered frequently in women with risk factor(s) in both the scanned and phone-interviewed group, but it reach statistically significant level in the group scanned 2 weeks later.
The drawn conclusion was that, ultrasound scan after delivery are highly necessary as a reference, when testing diagnostic efficacy of ultrasound in obstetrics and should be considered as an advantage for uncovering pathological conditions in the postpartum period. Reference values of the uterine artery resistance indices in the uncomplicated puerperium can help us to better understand normal physiology, and to better interpret pathophysiology of the puerperium.
We recommended that management decisions of postpartum women who experience complications should be based on the clinical picture and not on sonographic findings alone to avoid unnecessary surgical procedures; and we strongly advise the introduction of postpartum uterine scanning into obstetrical practice, most suitably provided around day 3 after delivery, especially for women with risk factors for puerperal complications. Further studies are required to investigate whether Doppler ultrasound of the uterine arteries may afford an additional diagnostic tool for the diagnosis of retained placental tissue and other puerperal complications.