An important diagnostic examination of the mother is ultrasound after childbirth: all the details of the procedure and the values ​​​​of the indicators. Ultrasound of the uterus after caesarean

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Questions and answers on: ultrasound suture after caesarean section

2014-10-10 06:46:00

Svetlana asks:

After physical exercises (rocking the press), yesterday I felt pain in the area of ​​​​the seam after a cesarean section (transverse seam). Seam is 27 years old. And today they just slashed me like a knife, also after the exercise. I can't bend over or bend over. I thought the inside seam had come apart. What can be, on ultrasound can show the reason?

Responsible Bosyak Yulia Vasilievna:

Good afternoon, Svetlana! In this situation, it is necessary to really undergo an ultrasound scan of the pelvic organs and consult a specialist with a conclusion. Be healthy!

2015-02-21 20:50:18

Maria asks:

I've had three cesareans. The last one was 11 months ago. I recently made an ultrasound diagnosis (thinning of the myometrium in the area of ​​the scar after cesarean section, adenomyosis and adhesions of the peritoneum of the small pelvis), the scar on the uterus is thinned to 1.9 mm, under thinning the uterine cavity is expanded to 6.3 mm over 5.8 mm. There are pains in the abdomen in the area of ​​the seam. The question is can the seam break? And what does it mean? Our gynecologists said that there is nothing to worry about.

2012-01-22 22:27:19

Ela asks:

Hello, I have a problem after a cesarean section. On the third day after the operation, the temperature jumped a lot, we could not determine the cause for a long time, it turned out that a hematoma formed inside, which was opened. Three years passed, a 13 mm thickening formed just above the postoperative suture, localization of pain in one place (at the site of compaction) during menstruation, especially. They didn’t really say anything by ultrasound, in this place the doctor noted a reduced echogenic zone. What is the likelihood of endometriosis of the scar or keloid? What additional inspection it is necessary to pass or take place (I am afraid of inevitability of a laparoscopy)?

Responsible Wild Nadezhda Ivanovna:

You may indeed have endometriosis. For diagnosis, observation, ultrasound in dynamics is necessary. Stop the progression of endometriosis. Combined oral contraceptives (COCs). It is necessary to do an ultrasound immediately after menstruation and on the eve of menstruation. And it will be possible to say whether there is endometriosis or not.

2012-12-03 17:07:29

Periwinkle asks:

Hello, I had a caesarean section, the operation was successful, a healthy girl was born. In the hospital, before being discharged, they didn’t examine me on the chair, they didn’t do ultrasound, they didn’t take blood, they said that there was no evidence. A day after discharge, aches began in the whole body, then the temperature rose to 38.3 degrees. solution, oxytocin, cefazolin 2 gr. intravenously. My question is the following, was it possible to determine earlier the closure of the cervix in a hospital setting? I had discharge after the operation for only 3 days, but the doctors did not ask me about the discharge, they only looked at the suture and touched my stomach.

Responsible Wild Nadezhda Ivanovna:

According to the new orders, the examination on the armchair is carried out strictly according to indications. It is not possible to predict how sh / m will behave. The frequency of breastfeeding is important. The more often you feed, the better the uterus contracts and pushes the lochia out of the uterus.

2012-03-09 20:08:22

Svetlana asks:

I was 43 had three births and 6 abortions also an ectopic pregnancy the last birth 5 years ago I got pregnant now I will give birth with my husband tell me if I can ask the doctor for a planned cesarean as I am afraid to give birth at this age my mother gave birth at 41 during childbirth I died on health I don’t complain, but in the previous pregnancy 5 years ago there was atrial tachycardia 156ud did an ultrasound of the heart in the myocardium there were changes, but the birth passed more or less, except for the fact that the cervix was opened manually, since after an ectopic it opened weakly and one-sidedly from the side of the seam I don’t want to risk myself not a child is it possible in my case a caesarean section thanks for the answer

Responsible Medical consultant of the portal "site":

Hello Svetlana! You can ask your doctor for a planned caesarean delivery, but think about this. A caesarean section is an abdominal operation, with the use of anesthesia or epidural anesthesia, a large load on the woman's body, the risk of various complications (bleeding, infection), and a relatively difficult postoperative period. Pre-existing cardiac problems can affect the course of the operation to a much greater extent than the course of a natural birth. In addition, you have already given birth to a woman three times - the fourth birth should not present any particular difficulty or problem for you. Therefore, asking for an operation for you is not quite the right decision. Discuss the situation with your doctor, with your husband, think for yourself (well) - and you will understand that natural childbirth in the absence of indications for a caesarean section is the best option for you. Take care of your health!

2011-10-23 17:01:29

Olga asks:

Hello! I really need your advice ... the fact is that now I am in a position, 28 weeks pregnant. second pregnancy, the first pregnancy was almost 4 years ago in March 2008. it ended with an emergency caesarean section, (I was pierced with a bladder, although there were no contractions, after that the contractions began, they were all night, in the morning they told me that the child did not descend, I needed to be caesarean, because for a long time to be without water ... everything is with the child I'm fine, 4160kg, but I lost a lot of blood during the operation, I felt very bad... the thought that I have to go through all this again just haunts me.My dream is to give birth on my own, but in our small town, doctors over my desire I don't want to, I don't want to suffer like this anymore after the operation, I still want many children! should I think about natural childbirth? the seam is vertical. maybe you need to send some tests? or ultrasound results. so that you at least guess if I have a chance!? you are my hope PLEASE ADVISE WHAT I SHOULD DO???!!! zara THANK YOU SO MUCH FOR YOUR ATTENTION AND UNDERSTANDING! VERY WAITING FOR ANSWER... OLGA, 24 years old, Republic of Sakha (Yakutia), Lensk

Responsible Tovstolytkina Natalia Petrovna:

Hello Olga. Now quite often after a caesarean section, vaginal births are performed. At the same time, there are clear contraindications for such childbirth, one of them is the failure of the scar on the uterus, which can be reliably determined in the first stage of childbirth. In addition, if you again have a large child (more than 4 kg), then there is a very high probability of rupture of the uterus along the old scar during vaginal delivery. I think that your uterus was cut transversely, only the skin was sewn up with a vertical suture, otherwise vaginal delivery is contraindicated. If there are also no other indications for a caesarean section (which may be in a normal pregnancy), then you can try to give birth yourself. Good luck.

2011-02-09 11:43:17

Svetlana asks:

Hello! I am 35 years old. In 2002 I had my first child. They did a caesarean section, arguing that I have a narrow pelvis and a large fetus (3800). The recovery seemed to go well. In 2009 I got pregnant again, the doctors were set only for the operation. The pregnancy proceeded normally, under the constant supervision of a doctor. She took the necessary tests on time, did an ultrasound. During the operation, problems began. Firstly, anesthesia had a bad effect on me, I “woke up” several times, so to speak, heard the doctor’s voice, his nervousness. Then the bleeding started. The placenta was attached to the anterior wall of the uterus, and the doctor could not tear it off. The operation lasted over two hours. As the doctor later told me, she already wanted to remove everything for me, as new foci constantly appeared. She got a lot of stitches. After this operation, I recovered within six months. And despite all the difficulties experienced, my husband and I would like to have another baby. Please tell me if this is possible? Where do we start? Thanks

Why do ultrasound during pregnancy - everyone knows about this: to find out how the embryo develops, to determine pathologies, to establish the health status of the expectant mother. After childbirth, an ultrasound examination is necessary in order to monitor the process in which the uterus returns to its original state, changed by the onset of pregnancy.

How long the process of contraction of the uterus and normalization of the processes taking place in it? About six weeks. During this time, an ultrasound is mandatory.

When is an ultrasound indicated?

If after childbirth there is wall rupture suspected uterus, ultrasound should be done in two hours. In other cases, the procedure is prescribed after 2-3 days.

Regulatory Criteria:

• slight expansion is observed;
• the cavity is slit-like;
• a lot of blood or clots have accumulated in the upper part;
• if the study is carried out 5 or more days after birth, the clots are displaced to the lower wall of the uterus.

Methods for conducting ultrasound: with the help of a vaginal probe and with the help of an apparatus, the uterine wall is examined through the abdominal wall.

How is a postpartum ultrasound done?

Process postpartum ultrasound practically does not differ from the usual method that was used when observing a woman at the time of her childbearing.

Transabdominal ultrasound

Carried out with a special device connected to the machine. Reminds me of a tube with a sensor. First, a special agent is applied to the skin in the abdomen area, which allows you to better see the state of the internal organ and its cavity, then the picture appears on the screen.

No pain or discomfort should be felt - the procedure is absolutely painless.

Vaginal ultrasound

This examination method is more complicated in that it is more difficult to assess the walls of the uterus during its implementation. However, if necessary examine the condition of the appendages and in general, the abdominal organs, it is necessary.

Talking about soreness It should be noted that the vaginal probe is placed in the uterine cavity and may cause some discomfort, especially if there were tears and stitches during childbirth.

Preparation for the procedure

Preparing for an ultrasound after childbirth is practically not required. The main thing when conducting an ultrasound examination is the absence of menstruation, however, if there is bleeding after childbirth, on the contrary, ultrasound is indicated urgently.

The most complete study can be carried out if you drink a liter of water two hours before the appointed time. The main thing at the same time is not to go to the toilet if you want. However, an overfilled bladder is also a problem.

It is better to go to the toilet first, and then, be sure to drink plenty of water two hours before the procedure - in this case, you will not lose.

Duration of the procedure usually reaches 10 minutes, sometimes less. If we are talking about a vaginal ultrasound, then no preparation is required - you don’t even need to drink water or monitor when you went to the toilet.

If you become bad after ultrasound be sure to tell your doctor. If a vaginal examination method was performed, infection is possible, but only if safety and hygiene rules are not followed.

When is a study after a caesarean scheduled?

Due to the physiological characteristics after caesarean section the uterus contracts for a longer time compared to natural childbirth. The main reason is trauma to the uterine cavity (an incision that is made in order to fully reach the child).

If there is a possibility of internal bleeding, ultrasound is prescribed immediately after surgery. If not, the study is carried out after 3-4 days. Often, bleeding still occurs, but in a small amount.

Parameters considered normal for normal childbirth, are also relevant for childbirth performed by caesarean section. However, the rate of uterine development is slower. The greater the chance of internal bleeding, there remains a high chance that the placenta will not be completely removed. Therefore, ultrasound after caesarean section is an important stage in recovery.

The norm of indicators of the size of the uterus

Exists special table, which spells out changes in the size of the uterus, which are considered the norm. The limits are calculated depending on the height and weight of the woman in labor, some features of her body.

• The length of the uterus on the second day after birth: 136-144 mm.
• The length of the uterus for 6-8 days after birth: 94-106 mm.
• The width of the uterus on the second day after birth: 133-139 mm.
• The width of the uterus for 6-8 days after birth: 95-105 mm.
• Anteroposterior size on the second day: 68-72 mm.
• Anteroposterior size on days 6-8: 61-69 mm.

The results are deciphered by a specialist in ultrasound diagnostics and an obstetrician-gynecologist. The uterus should not be tilted back, the external contours should be distinguished by clear lines. The size of the uterus is measured using a computer program.

Echogenicity should be homogeneous - this can be seen visually when examining the uterine cavity on the screen. The structure and size of the cervix is ​​​​estimated - it should gradually close depending on the time elapsed after childbirth.

If at least one pathology was detected in a woman in labor, then either at the stage of therapy or after it, more ultrasound examinations are prescribed. The frequency of ultrasound does not affect the health of the woman and does not affect the quality of breast milk.

Uterus contraction

Usually, a woman's uterus after childbirth weighs 1 kg. Within a week, her weight is halved, then, after another week, by another 35%, then reaches 250 grams (average). Two months after the birth of the baby, the uterus should weigh 75 grams.

Main problems and pathologies

If anomalies are recorded by the doctor, the problem is solved in the near future. This will avoid complications and the development of diseases.

Clot accumulation

What problems can arise? First of all, this accumulation excessive clots blood in the uterine cavity. If for one of the reasons the placenta remains, ultrasound helps to establish this, in which case it is necessary to take action. Usually, in a maternity hospital, cleaning is carried out if the woman in labor has not yet been discharged.

Expansion of the uterus (subinvolution)

Overly enlarged uterus, which does not decrease in size - this is also possible. Usually, appropriate drugs are prescribed to carry out the process of contraction of the muscles of the uterus.

endometritis

With this disease uterus is too weak, gases accumulate in it, often the remains of the placenta and other membranes of the fetus remain. The solution to the problem is the appointment of drugs that help the uterus contract, as well as antibiotics.

So, yesterday we started talking about what happens to a woman in the postpartum period and how it is possible to detect health problems in the early stages and the formation of serious postpartum complications with the help of an ultrasound examination. This helps at the initial stage to carry out active treatment, which will allow a woman to maintain childbearing functions and not earn herself chronic pathologies for life. So, what can specialists of a maternity hospital or antenatal clinic see on an ultrasound examination in the postpartum period?

Formation of postpartum endometritis

Postpartum endometritis is called inflammation of the endometrium of the uterus (its inner mucosa). When conducting an ultrasound examination, the main signs of endometritis may be a decrease in the tone of the uterus and a fairly pronounced expansion of its cavity, the accumulation of gases in the uterine cavity, the presence of remains of placental tissues or fragments of membranes in it. It is important for you to understand that you need to start treatment as early as possible so that you can spend as little time in the hospital as possible, and you can be discharged home with your child faster. Women with endometritis are prescribed strict bed rest to reduce the spread of inflammation, an active course of antibiotics (usually injected intramuscularly) and drugs to speed up the contraction of the uterus are required. If treatment is not started immediately after the diagnosis is established, endometritis can go into a very severe stage, which may even require surgery to remove the uterus and can really threaten the life and health of a woman who has recently given birth. However, in fairness it should be noted that today this pathology, due to timely diagnosis and prevention, is rare, in about 2% of cases of women who have given birth naturally.

Formation of postpartum hemorrhage

Postpartum hemorrhage can be a serious complication of natural or operative childbirth. Conducting an ultrasound examination on the second or third day from the moment of birth will prevent such formidable complications in the postpartum period. Bleeding can start suddenly and can be very heavy at times. Often, the causes of incipient bleeding can be the remnants of placental tissues remaining in the uterine cavity, the remnants of the fetal membranes inside the uterine cavity, and this is easily diagnosed during ultrasound control after childbirth. In such cases, in order to stop the bleeding, it is necessary to carry out therapeutic curettage inside the uterine cavity and promptly remove the remnants of placental tissues. If any pathologies were found during the initial ultrasound examination in the postpartum period, then the study is carried out with the regularity necessary to track the dynamics of the process and evaluate the effectiveness of the measures taken. In the case of positive dynamics and good results of control ultrasound, a young mother with a baby is discharged from the maternity hospital under the supervision of antenatal clinic doctors. But in case of the slightest doubt, the doctor will immediately send the woman to the gynecological hospital.

After a caesarean section

A caesarean section is a special type of genital surgery that allows a baby to be born. And like any operation, this one is also not performed just like that, without indications, for its implementation it is necessary to have certain indications - relative or absolute. And after a caesarean section, the uterus will return to its previous size much more slowly than the same process occurs during natural childbirth. The reasons for this are the violation of the structure of the muscle fiber in the area of ​​​​the uterine wall due to the incision and subsequent suturing, which gives the formation of a scar on the uterus. The size and shape of the uterus, as it was before pregnancy, the uterus, when performing a caesarean section, acquires only on the 10th day of the postpartum period.

In addition, performing a caesarean section in a woman in labor in itself quite seriously increases the risks of various complications. More often there are phenomena of endometritis after childbirth, the frequency of bleeding increases, and they can be external, blood is poured from the vagina, and internal bleeding with accumulation of blood in the abdominal cavity. That is why ultrasound research methods, as the simplest and most non-traumatic, play a leading role in monitoring young mothers who have given birth operatively.

Usually, an ultrasound examination in the area of ​​the uterus and reproductive organs of a woman who has given birth to a child by caesarean section is prescribed from the third to the fourth day after the operation. But sometimes, in some cases, according to the doctor's prescription, ultrasound examinations can be prescribed during the first few hours after the operation in order to exclude bleeding in the abdominal cavity or violation of the integrity of the suture on the uterus, its ruptures or other problems. The study should be carried out in the presence of typical complaints of women, especially with abdominal pain, in the presence of poor blood tests, especially with a sharp decrease in hemoglobin and hematocrit after surgery. An ultrasound examination can be performed both through the anterior abdominal wall (transabdominally) and through the vagina with a vaginal probe.

On ultrasound, approximately the same parameters are evaluated as in conventional natural childbirth, but in addition, a mandatory study of the scar in the uterus is carried out. Often, it is the condition of the scar that will be evidence of certain pathologies, for example, an ultrasound sign of postpartum endometritis during cesarean section is swelling of the uterine sutures. The healing of sutures during cesarean section does not always go smoothly, in such cases, ultrasound helps in the diagnosis of hematomas (blood accumulations) in the area of ​​the surgical scar, and also helps in monitoring the size and size, location of hematomas, determines the choice of treatment method.

Ultrasound for control in case of identified pathology is carried out repeatedly, as prescribed by a doctor to assess the dynamics of the process and the effectiveness of treatment. With positive dynamics and no danger to the woman's health, she is discharged home from the maternity hospital under the supervision of a antenatal clinic doctor. It is imperative that when conducting an ultrasound scan of a woman after childbirth, whether it is natural childbirth or a cesarean section, they assess the condition of the ovaries, and also check for the presence of fluid or blood clots in the abdominal cavity, in the pelvic area - under normal conditions, they should be absent. In addition, it is important to assess the condition of the uterine veins and the surrounding tissue.

After leaving the hospital

If you did not have an ultrasound for some reason while still in the hospital, it must be done at the antenatal clinic along with a visit to the gynecologist during the first week after discharge from the hospital home. It is also important to decide on the need for an ultrasound if this study was conducted in the maternity hospital and there were any manipulations or therapeutic actions. So, all women who are at risk for the formation of postpartum complications, as well as those who had complications in childbirth, must undergo an ultrasound of the uterus five to eight days after discharge from the hospital. Ultrasound in these terms will help in preventing late complications or recurrence of endometritis. The risk group is multiple pregnancy and polyhydramnios, prolonged labor and blood loss during labor, a long anhydrous period, manual control over the separation of the placenta.

If, according to the results of ultrasound in the maternity hospital, everything was fine, this does not exclude the formation of late complications of the ear at home, a mandatory visit to the doctor and an ultrasound scan for control after discharge from the maternity hospital are necessary. It is imperative to go to the gynecologist in the first month after childbirth, and the examination doctor will determine the need for an ultrasound scan, if there are no deviations, the next visit to the doctor awaits you six months after the birth.

To whom and when is an ultrasound indicated?

Indications for immediate ultrasound after childbirth can be:

Increased blood flow from the genital tract, which may indicate the presence of placental remnants in the uterine cavity, a placental polyp, which is clearly visible on ultrasound and is an indication for curettage of the uterine cavity;
- an increase in temperature, a change in discharge, the appearance of an unpleasant odor, an increase in the volume of lochia, the appearance of blood after it has already stopped, which may indicate bleeding or an infection. This requires the start of immediate treatment;
- painful and unpleasant sensations in the lower abdomen, in the area of ​​​​the scar from a cesarean section, which may indicate the failure of the suture or its divergence.

During the perinatal period, the female reproductive system undergoes a certain biological transformation. The return of internal organs to an adequate state takes an average of one and a half months. To control this process, a mandatory ultrasound procedure after childbirth is provided. The greatest number of complications is recorded in the first postpartum week. Ultrasound examination is the only highly informative and affordable method for diagnosing distorted manifestations of the reproductive system during the recovery period of a woman after childbirth.

Changes in the uterus in the postpartum period

After natural delivery, with a short time interval, the placenta with the membranes of the fetus (afterbirth) is “born”, the uterus begins to contract vigorously. These contractions cause sharp pain in the lower abdomen. The organ works in an active mode, on the 5-7th day the uterus contracts three times, by the 10th day - ten times, that is, it takes on dimensions corresponding to the state before pregnancy. At the same time, the uterus is shifted to the place of its anatomical location. The shape of the reproductive organ (spherical uterus) changed during pregnancy returns to its natural pear-shaped form within a week.

The contraction time increases in the following cases:

• carrying out an operation for artificial delivery (caesarean section);
• multiembryonic pregnancy;
• artificial feeding (a woman does not release the hormone oxytocin, which stimulates contractile activity);
• excess amniotic fluid (polyhydramnios);
• trauma during childbirth;
• coagulation disorders (poor blood clotting).

These reasons require increased attention from the gynecologist. Low contractile activity of the uterus can lead to serious postpartum complications, in particular: inflammation of the intrauterine mucosa (endometritis), uterine bleeding, impaired outflow of postpartum secretions (lochia), bending of the reproductive organ, formation of a barrier in the vagina, due to the accumulation of postpartum clots. The task of doctors is to prevent unwanted complications, or fix them at the initial stage, which is why they do ultrasound after childbirth.

Normal transformation of the uterus after childbirth

Control procedure

A standard postpartum ultrasound examination is performed 2–4 days after the date of delivery. In case of unnatural delivery (cesarean), the doctor prescribes the timing of the procedure on an individual basis. Urgent ultrasound should be done when a woman has the following symptoms:

• copious separation of clots;
• intense outflow of blood from the vagina;
• febrile or pyretic body temperature (38-41 ° C);
• unbearable pain in the internal organs;
• soreness, swelling, wetting of the postoperative suture (in case of caesarean section).

According to the results of ultrasound diagnostics, conservative therapy or emergency surgery is prescribed to eliminate the complications that have arisen. The control ultrasound is carried out in the hospital and only after that the woman is discharged home. A re-examination should be done in a week.

Preparation and holding

Since the process of childbirth is already over and there is no amniotic fluid, it is necessary to fill the bladder before the study to visualize the uterus before the study. The amount of liquid drunk should be at least two liters. In the case of an urgent procedure, fluid is injected through a catheter, followed by diuretic medication.

After childbirth, ultrasound is usually performed by the abdominal, that is, external method. Transvaginal (internal) examination is informative only when examining the cervix. The organ itself is still too voluminous, so the intravaginal sensor will not give an objective result. The time interval of the procedure is from 20 to 40 minutes, depending on the health of the reproductive system.

Study parameters

Postpartum examination of the organs of the patient's reproductive system is aimed at identifying possible pathologies leading to complications. The assessment is made according to the following parameters:

• contractility, location and size of the uterus;
• the presence of organic formations (pieces of the "children's place", blood clots, fragments of the fetal membrane);
• the presence of excess fluid in the uterine cavity;
• possible inflammatory processes of the endometrium;
• condition of the postoperative suture (if a caesarean section was performed);
• general condition of the pelvic organs.

The indicators obtained during ultrasound diagnostics are compared with average standards. In case of discrepancy between the values, the patient is assigned a special treatment. With an uncomplicated postpartum period, it is recommended to visit a gynecologist in a month. At the appointment, the doctor will determine the need for monitoring through ultrasound.

Changes in the uterus: immediately after delivery, after a week, after 5 weeks

Normative indicators of the reproductive system in the postpartum period

Features of the restoration of the internal genital organs depend on the method of delivery (naturally or through a caesarean section).

Rehabilitation after natural childbirth

After the natural birth of the baby, the ultrasound examination procedure is prescribed from the second to the fourth day. In the case of complicated childbirth, if uterine rupture is suspected, ultrasound is done immediately. On longitudinal examination, the uterus has an elliptical shape. The organ is located in the middle part of the small pelvis. Some downward displacement is observed after the birth of two or more children or one large baby.

On the study, you can track the dynamics of reducing the mass of the uterus and narrowing the size. The decrease in the volume of the uterus and its movement to the natural location takes place gradually. The advance rate is 1-2 cm daily. In terms of weight, the organ loses about half of its mass (400–500 grams) in the first week. Further, weight loss occurs smoothly, approximately 100 g per week, to the original 90-100 grams. The main indicators that the doctor measures on the monitor during the study relate to the uterus itself and the uterine cavity.

Average digital values ​​of parameters

Ultrasound diagnostics after caesarean section

Rehabilitation of the reproductive system after cesarean lasts longer, since the weight and size of the uterus after surgery increase, on average, by 40% compared to natural labor. During the ultrasound, the doctor can observe small hematomas in the area of ​​the postoperative scar. They are not dangerous, but they impede the passage of ultrasonic waves. Swelling of the scar may indicate the onset of an inflammatory process in the endometrium.

Optimal condition of the postoperative scar

The uterus decreases by 200-250 grams in the first seven days. The organ returns to its original mass parameters after about eight weeks. In form, it takes on its original form no earlier than 10-12 days. The main measurement parameters (length, width, anterior-posterior size) also lag behind in terms of natural childbirth. After operative delivery, a more thorough ultrasound diagnosis of the ovaries and blood vessels is performed to ensure their integrity.

The control ultrasound procedure is prescribed individually, depending on the results obtained.

Possible Complications

Ultrasound after childbirth helps to identify a number of problems that, if not addressed in time, can lead to serious complications. The most common pathologies that ultrasound shows include:

• The concentration of organic clots. The clots formed in the uterine cavity consist of coagulated blood, fragments of the fetal membrane, particles of the "children's place". The accumulation of organic fragments prevents the outflow of postpartum secretions, and can provoke inflammation or latent (low-intensity bleeding). To eliminate the problem, a woman is assigned a vacuum aspiration.
• Weak contractile activity or subinvolution of the uterus. Such a diagnosis is made in the case when the indicative parameters of the uterus do not fit into the normative values. The prescription of special medications to reduce smooth muscles in parallel with antispasmodics that improve the outflow of lohania helps to correct the process.
• Inflammation of the intrauterine mucosa (endometritis). The cause of the disease is most often a bacterial infection. Pathogens penetrate into the uterine structures from the lower parts of the reproductive system, in case of prenatal violation of the vaginal microflora.

In addition, endometritis lead to:

• delayed rupture of the fetal membranes;
• inflammation of the outer and inner membranes of the fetus, which appears during pregnancy and childbirth (chorioamnionitis);
• intervention in the process of delivery (caesarean section or manual separation of the "children's place");
• excessive blood loss during childbirth;
• improperly performed childbirth.

The last item includes injuries to the perineum or genital organs received by a woman during childbirth. With endometritis, antibiotic therapy, bed rest, and dietary nutrition are indicated. In complicated cases, the woman remains on inpatient treatment in the gynecology department.

Compared with physiological childbirth, the frequency of postpartum complications after a planned caesarean section increases by 4-5 times, after an emergency - by 6-7 times

After discharge

The woman is re-examined at the place of residence, in accordance with the planned period. Indications for emergency diagnosis are:

• copious vaginal discharge with a pungent odor;
• bleeding;
• pain in the pelvis (often accompanied by a disorder of urination and stool);
• suppuration and swelling of the scar after caesarean section;
• prolonged hyperthermia, not associated with colds.

If, for any reason, an ultrasound examination was not performed during the stay in the maternity ward, it is necessary to do it yourself, regardless of the presence of alarming symptoms.

postpartum period - this is the period of time during which a woman who has given birth undergoes a reverse development (involution) of those organs and systems that have undergone changes in connection with pregnancy and childbirth. Usually, this period, taking into account individual characteristics, begins immediately after the separation of the placenta and lasts up to 6 weeks.

Immediately after the birth of the placenta, the uterus decreases significantly in size. Its bottom (upper part) at this moment is at the level of the navel. The next day after childbirth, the bottom of the uterus drops somewhat and is located just below the navel. On the 4th day, it is already determined in the middle between the navel and the womb. On the 8-9th day, the bottom of the uterus can still be felt at the level of the womb or slightly above it. An important indicator is the change in the shape of the uterus. On the 3rd day after birth, it is spherical, by the 5th day it is oval, and by the 7th day it becomes pear-shaped, as before pregnancy.

Changes are also observed in the nature of the discharge from the genital tract (lochia). The discharge in the first 2–3 days after childbirth looks like bright red blood, from the 3rd–4th day until the end of the first week it is paler, sanious, and then the lochia brighten even more, acquire a yellowish tint, become mucous. On the 5-6th week of the postpartum period, spotting stops completely and has the same character as before pregnancy.

during this period, it helps the doctor to objectively assess the condition of the organs of the reproductive system of a woman after childbirth and, if necessary, to conduct timely treatment of certain complications.

After natural childbirth

During the early postpartum period (that is, in the first 2 hours after birth), ultrasound is used for suspected uterine rupture and for heavy bleeding to diagnose their causes.

In the normal course of the postpartum periodUltrasound of the uterusmost often carried out on the 2-3rd day after childbirth. The transabdominal method is usually used (examination of organs through the anterior abdominal wall). This choice is explained by the fact that the uterus is still quite large in size, and it is difficult to examine it completely with a vaginal probe. In some situations, if a more detailed examination of the cervix is ​​necessary, the vaginal ultrasound diagnostic method is also used.

One of the important criteria to be assessed is the condition of the uterine cavity. Normally, it is slit-like or slightly expanded due to the presence of a small amount of liquid blood or blood clots, which at this time may be in its upper part, and by the 5–7th day they are shifted to the lower sections. An ultrasound doctor can see a change in the uterine cavity - its excessive expansion, the presence of membranes in it, remnants of placental tissue, excessive accumulation of liquid blood or its clots, all this helps to prevent serious complications of the postpartum period. The size of the uterus is also estimated, and then they are compared with the normative tables developed for the normal course of the postpartum period.

Complications after childbirth

Subinvolution of the uterus . Sometimes, when examining a patient, the doctor notes that the size of the uterus exceeds due. This may be a physiological condition, for example, after a multiple pregnancy, childbirth with a large fetus, polyhydramnios, in multiparous women. In other cases, such a discrepancy is considered pathological and is called subinvolution of the uterus, i.e. slowing down its development. In situations like thisallows you to identify the cause of the deviation from the norm and helps the obstetrician-gynecologist determine further tactics of action. This complication occurs in about 1.5% of women who have given birth.

With insufficient contraction of the uterus during the first 5 days, the woman’s condition is monitored and drug treatment is prescribed - drugs that reduce the uterus, as well as antispasmodics that relax the muscles of the cervix, are prescribed to ensure a full outflow of contents. If a large number of large blood clots are detected on ultrasound in the uterine cavity, it may be necessary to vacuum aspirate (remove blood clots using vacuum suction) or curettage of the uterine cavity. If they are not removed in a timely manner, an infection from the vagina can enter the uterus, and a severe complication of the postpartum period will develop - endometritis (inflammation of the inner lining of the uterus). Therefore, timelycan significantly reduce the risk of developing this disease.

Postpartum endometritis . Ultrasound signs of endometritis are a decrease in uterine tone, expansion of the cavity, accumulation of gas in it, remnants of placental tissue or fetal membranes. It is important to understand that the treatment of endometritis must be started as early as possible. The woman is prescribed bed rest, a course of antibiotics and means that reduce the uterus. If treatment is not started on time, endometritis becomes severe, which may require removal of the uterus and even threaten the life of a woman. But it is important to note that this disease is quite rare - in about 2% of women after childbirth through the natural birth canal.

Postpartum bleeding. Ultrasound on the 2-3rd day after childbirth can prevent very formidable complications of the postpartum period - bleeding, which can begin suddenly and are very plentiful. Often they are caused by remnants of placental tissue or membranes in the uterine cavity, which is easily diagnosed by ultrasound. In such cases, to stop bleeding, it is necessary to scrape and remove the remnants of placental tissue.

If at the first any pathology is detected, ultrasound is done several more times during and after treatment in order to evaluate the effectiveness of therapy. And only if the results of the control study are good, the young mother can be discharged home under the supervision of a antenatal clinic doctor.

After caesarean section

After a caesarean section, the uterus returns to its size more slowly than after a vaginal delivery. This is due to a violation of the structure of the muscle fibers of the uterine wall due to the incision made during the operation. It takes the size and shape as before pregnancy only by the 10th day of the postpartum period.

After a cesarean section, a woman in labor significantly increases the risk of various complications - postpartum endometritis occurs more often and more severely (6-11% of cases), the frequency of bleeding is higher (about 5%), both external - from the vagina, and internal - into the abdominal cavity. Therefore, ultrasound examination plays an invaluable role in the observation of such young mothers.

In most cases, an ultrasound examination of the organs of the reproductive system is performed for women in labor on the 3rd–4th day after surgery. Butmay also be prescribed within a few hours after the end of the operation to exclude bleeding into the abdominal cavity and violation of the integrity of the sutures on the uterus. A study is carried out if a woman complains of intense abdominal pain or with unsuccessful blood tests, in particular, with a decrease in hemoglobin levels after surgery.

Ultrasound diagnostics after caesarean section can be performed with both transabdominal and vaginal sensors.

With the help of ultrasound, the same parameters are evaluated as after natural childbirth. But, in addition, a mandatory examination of the postoperative scar on the uterus is also carried out. Often, deviations in his condition indicate the development of certain complications. So, for example, a specific ultrasound sign of developing postpartum endometritis after caesarean section is swelling of the sutures on the uterus.

Unfortunately, the healing of sutures after the operation is not always successful. In these cases, ultrasound helps to diagnose hematomas (blood accumulations) in the scar area, monitor their size and location, and, based on this, choose a treatment method.

When any pathology is detected, control ultrasound examinations are carried out repeatedly, assessing the state in dynamics. After achieving positive results of treatment, the young mother is discharged home under the supervision of a antenatal clinic doctor.

Without fail, ultrasound in women after childbirth (natural and after cesarean section) also assesses the condition of the ovaries, the presence of fluid and blood clots in the abdominal cavity, in the small pelvis, which are normally absent, as well as the condition of the uterine veins and surrounding tissue.

After discharge from the hospital

If for some reason an ultrasound scan was not done before discharge from the hospital, then it is necessary to visit the gynecologist of the antenatal clinic within the first week after returning home and decide on the need for this study.

All puerperas who are at high risk for developing postpartum complications, and anyone who had complications immediately after birth, are strongly advised to repeat the ultrasound of the uterus 5-8 days after discharge from the hospital. A study carried out within these terms will help prevent late complications or their repetitions. The risk group includes women with multiple pregnancies, polyhydramnios, prolonged labor, large blood loss during childbirth, a long interval between the outflow of amniotic fluid and the birth of a baby, manual separation of the afterbirth.

However, even if everything was in order during the ultrasound in the maternity hospital and nothing bothered the woman at discharge, it must be remembered that complications may arise even in the late postpartum period. Therefore, a young mother is advised to contact a gynecologist about a month after giving birth, and at the appointment the doctor will determine the need for an ultrasound scan. If no abnormalities are found, then the next visit to the doctor and preventive ultrasound should be scheduled after about 6 months.

Indications for ultrasound

Indications for urgent medical attention and pelvic ultrasound are increased bloody discharge from the genital tract, which may indicate a delay in the uterine cavity of the placenta - the so-called placental polyp (an outgrowth on the wall of the uterus from placental tissue).

Usually, the polyp is clearly visible on ultrasound. In this case, it is necessary to carry out curettage of the uterine cavity.

Also, a young mother should be alerted by an increase in body temperature, changes in the nature of the discharge - the appearance of lochia with an unpleasant odor, purulent. Similar symptoms may indicate the development of postpartum endometritis.

Pain in the lower abdomen, in the area of ​​​​the seam after a cesarean section, and the appearance of discharge from it deserve close attention. Such manifestations can be observed with the inferiority of the suture, its divergence, which may require additional surgical treatment.