Norms of the size of the uterus according to ultrasound during pregnancy and after childbirth. Normal sizes of the uterus and ovaries on ultrasound in adolescents and adults. The size of the cervix on ultrasound: the norm. Ultrasound after caesarean section

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.

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question about "ultrasound after caesarean section" and get a free online consultation with a doctor.

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

After any surgical intervention, there is a risk of infection, inflammation and other complications, so ultrasound of the uterus after cesarean section is always done.

Ultrasound of the uterus after caesarean section

The specialist diagnoses a few clots in the area being examined, which remain in the uterine cavity after a cesarean section and are clearly visible on ultrasound. Over time, clots descend to the bottom of the organ. The examination is carried out in the first few days after childbirth and during the entire recovery period.

Why do you need to do an ultrasound after childbirth

Ultrasound of the uterus after childbirth, especially if there was a caesarean section, helps specialists monitor the condition of the internal organs of a woman. Having identified deviations from the normal course of recovery in time, the doctor can prescribe a course of treatment.

In addition, during surgery, a scar from the suture may remain on the inner surface of the uterus, which will affect subsequent births. Therefore, experts recommend that it is mandatory to do an ultrasound of the scar on the uterus after a cesarean section.

How does the uterus change after cesarean?

The uterus is large and has an injured inner surface. Over time, there is a process of healing and reduction. Ultrasound captures a decrease in the size and weight of the uterus, however, after a cesarean section, the process is slower and is accompanied by postpartum discharge.

It is important for a specialist to monitor the state of internal organs after surgery and stimulate the speed of their recovery with the help of medications, if necessary. Therefore, regular ultrasound of the uterus is especially important after a caesarean section.

Preparing for an ultrasound

Ultrasound of the uterus, even after a cesarean section, does not require special preparation. It is enough for the patient to take a horizontal position, the specialist does the rest. The procedure lasts no more than 15 minutes and does not cause discomfort.

How is an ultrasound of the uterus done after a cesarean?

Most often, the examination is carried out on the first day after childbirth, that is, through the abdominal wall. carried out after a cesarean section, when a specialist needs to determine the condition of the cervix. Then the sensor is inserted into the vagina. The question of when to conduct an ultrasound of the uterus after a cesarean section and how to do an examination, the specialist decides based on an analysis of the patient's condition.

What will ultrasound of the uterus after cesarean show?

The recovery period can last up to 6 weeks after delivery. In a month and a half, the organs of the reproductive system involute - they return to the state before childbirth. The process can be complicated, so the size of the uterus, shape and other important changes after a caesarean section should be monitored by an ultrasound specialist.

By the end of the 3rd day, the shape of the uterus should become round. In the future, changes in the contours on ultrasound of the uterus will be more and more noticeable, by the 5th day after cesarean section, it should become oval. In a normal postpartum recovery, the uterus will be pear-shaped after a week.

Another important indicator of normal involution is the position of the uterus. On the 4th day, she occupies a position between the navel and the pubis. On the ultrasound of the uterus, made on the 9th day after the caesarean section, it will be higher than the womb.

Uterine dimensions

Normally, a decrease in the ultrasound of the uterus is more and more noticeable every day after a cesarean section. On the 2nd day, its normal length and width will be 13.6-14.4 cm and 13.3-13.9 cm, respectively. On ultrasound of the uterus on the 4th day after cesarean section, it should normally be 11.5-12.5 cm long and 11.1-11.9 cm wide. On the 8th day, it should not exceed 10.6 cm in length and 10.5 cm in width.

On ultrasound, it is possible to determine the weight of the uterus, every day after a cesarean section, it should decrease. On the 7th day, the organ should weigh 500-600 g, after two weeks - 350 g. On the 3rd week, the normal weight for the uterus is 200 g, and after six weeks - 60 g.

Clots in the uterus after cesarean on ultrasound

Clots on ultrasound of the uterus immediately after cesarean section are concentrated in the upper sections. With normal recovery, after seven days, the clots should become smaller, they should shift down.

If clots on ultrasound of the uterus continue to appear for a long time after a cesarean section, an inflammatory process has most likely begun. Then the uterus will contract more slowly than it should, and its internal cavity will be deformed and expanded.

What kind of discharge is normal after a caesarean?

Immediately after surgery, constant monitoring is required. Specialists look after the patient's standing and carefully monitor the amount and nature of discharge from the uterus. In the first 5-7 days, they resemble discharge during menstruation, but are more abundant (up to 500 ml). Usually the discharge is red and contains clots.

Over time, the number of lochia decreases, their color becomes darker. By 4-5 weeks they become very small. The color of the discharge is dark. The process of restoration of the uterine mucosa ends by 6-8 weeks. By this time, the discharge should not differ from the discharge before pregnancy.

The instinct of motherhood makes a woman in labor forget about all her problems and think only about the health of the baby. Such an approach can lead to the emergence of various pathologies in a young mother, and primarily from the side of the uterus.

Specialists of maternity hospitals and perinatal centers after the birth of a child take on most of the care for the normal course of the early postpartum period. This set of measures necessarily includes an ultrasound of the uterus after childbirth.

Read in this article

Features of ultrasound after childbirth

The time of the first session of ultrasound examination of the body and uterine cavity is usually chosen by the attending physician. Most often, when prescribing a procedure, gynecologists are guided by the duration and severity of childbirth, the general well-being of the patient. Be sure to take into account the fact whether there were independent births or surgical intervention was required.

In the normal condition of the patient during the stay in the maternity hospital, the first ultrasound is performed in a medical hospital on the 4th - 6th day after the end of the birth process.

Usually, the use of this method of examination of a young mother allows doctors to make sure that there is no pathology from the uterus and discharge the woman from the maternity hospital.

If the patient’s uterus does not contract well during the first hours, which is usually manifested by abdominal pain and profuse bloody discharge from the vagina, then ultrasound can be performed already on the first day after the birth of the child. These measures will help determine the level of threat to the life and health of the lady and develop appropriate treatment tactics.

During the first ultrasound session, vaginal probes are usually not used, which are widely used during examinations at gynecological appointments and in pregnant women. Due to technical difficulties, it is recommended to confine oneself to the usual abdominal method, that is, the structure of the uterus is examined through the anterior abdominal wall.

How is the procedure done

Ultrasound after childbirth does not require any special preparation of the patient. The main recommendation is to fill the woman's bladder with at least 1 liter of fluid. This effect can be achieved if a young mother drinks this amount of water and refrains from going to the toilet for 2-3 hours.

If an emergency procedure is required, then a woman can inject solutions directly into the bladder through a catheter, while diuretics are prescribed to stimulate her own diuresis. The filled bladder becomes an acoustic window that helps to better view the lady's genitals, especially the uterus.

The examination itself is usually carried out with the patient lying on her back. The surface of the abdomen before ultrasound is lubricated with special gels that improve the conductivity of ultrasonic waves.

Modern equipment allows doctors to use both linear and sectoral sensors to examine the uterus. Such a combined scan makes it possible to obtain an image of oblique, longitudinal and transverse sections at various levels, which significantly expands the possibilities for diagnosing postpartum pathology.

The session itself, in the normal state of the uterus and the absence of various pathological symptoms, usually does not take more than 20 minutes. However, if gynecologists need to establish the correct diagnosis or determine the severity of the pathological process in the internal genital organs, the ultrasound time can increase by 2-3 times. This should be taken into account by lactating women in order to prepare milk for the baby during the absence.

What will ultrasound of the uterus show

When an ultrasound examination of the internal genital organs of a woman is performed in the early postpartum period, doctors are primarily interested in the following parameters:

• The presence in the uterine cavity of blood clots or simply a large volume of liquid blood.
• Are there any remnants of childbirth in the organ under consideration: pieces of placental tissue or parts of the fetal membranes.
• Does the rate of uterine contraction correspond to normal physiological parameters.

Reliable answers to these questions will allow gynecologists to conclude how normal the period after childbirth is, whether medical correction of this process is required.

Watch the video about ultrasound after childbirth:

The size of the uterus is normal after childbirth

When conducting the first ultrasound of the uterus after childbirth, the organ on the monitor screen may look different. It all depends on the method of examination: with a transverse scan, the uterus appears to specialists as an ovoid body, and if doctors use longitudinal sections, it takes the form of an ellipse.

Usually the reproductive organ after childbirth is in the middle position relative to other organs of the small pelvis. But if a child was born over 4 kilograms, then in 70% of cases, doctors ascertain the displacement of the bottom of the uterus back.

Most often, to determine the true size of the postpartum organ, length indicators are used, that is, the distance from the internal pharynx to the outer surface of the bottom of the uterus. In addition, experts must measure the width, that is, the distance between the two most distant points of the organ walls in relation to the longitudinal axis.

Thanks to these data and the use of special formulas, gynecologists accurately determine the volume of the uterus, which is very important for monitoring its condition after childbirth. It should be borne in mind that this indicator may also depend on the shape of the reproductive organ. If in the first week after childbirth the uterus usually has the shape of a ball, then by 8-12 days it takes the form of a pear.

During the normal course of the first week after the birth of a baby, the size of the reproductive organ is constantly decreasing: on the 3rd day after birth, the length is usually equal to the width and ranges from 135 to 145 cm, and by the end of the first week, these parameters decrease, respectively, to 95 - 105 cm.

There is also a decrease in the volume of the uterine cavity and its mass. The volume for 3 - 4 months after childbirth decreases by 2 times, and the total weight for the same period decreases from 1200 grams to 70 - 90 grams, that is, almost 15 times.

What will ultrasound show after cesarean

After a caesarean section is performed on a woman, first of all, experts note an increase in density in the lower segment of the uterine body, that is, exactly in the place where the incision took place. At the same time, the conductivity of ultrasonic waves in the area of ​​the scar most often depends on the suture material used.

Quite often, gynecologists on the monitor screen observe foci of poor conductivity of a round shape in this area. The cause of such an anomaly is most often small hematomas in the scar area, which do not threaten the woman's health.

The process of recovery of the uterus after operative delivery usually takes longer than if the lady gave birth to a child in the usual way. There are several reasons for this phenomenon:

• Reducing the size of the genital organ after surgery often occurs 2 times slower. If after a normal birth in the first 5 - 7 days the uterus contracts by 35% - 40%, then after a cesarean section for a similar time period, the woman's genitals will decrease in volume by only 15%
• In this category of women in labor, the uterus usually does not change its shape over time, that is, it was round after the operation, and remains throughout the postpartum period.
• It should be noted that the mass and size of the uterus after surgery as a whole is 40% higher than the size after physiological childbirth, even if the weight and size of the child are almost the same.

Based on this picture of the course of the early recovery period in operated women, the general rules for managing young mothers and the timing of ultrasound are not very suitable for them. This contingent requires closer attention, since the absence of pathology during uterine contraction after childbirth can be fully assessed only with the help of constant monitoring, including ultrasound.

Why ultrasound showed clots

In obstetric practice, there are situations when clots are detected during ultrasound in the early postpartum period. Most often, such a pathology is explained by a delay in the uterine cavity of parts of the placenta, the remains of the placenta, a large amount of fresh or clotted blood that has arisen as a result.

If the patient is diagnosed with a “hematometer” or “lochiometer”, then during an ultrasound scan, it must be confirmed by an increase in the volume of the uterine cavity and the presence of a spherical shape in this organ. Usually, with such a pathology, the uterus itself is evenly expanded, and the mosaic pattern of the passage of ultrasonic waves indicates the accumulation of a large amount of blood in its lumen.

Such symptoms are most often observed in 3-5 days after childbirth. If this process is detected at 2-3 weeks, then the uterus will already have the shape of a pear. This usually occurs due to the expansion of the lower sections.

Other problems that the survey will reveal

Not only the presence of blood in the uterine cavity or the long-term consequences of the operation can provoke a deterioration in the condition of a young mother. Quite often, the use of ultrasound diagnostics in the early postpartum period helps to identify inflammation of the body of the uterus.

If there is an organ in the wall or the picture during ultrasound will be somewhat different. Possible clots in this case will indicate a decrease in the contractile activity of the reproductive organ and a decrease in muscle tone. In this case, the volume of the diseased organ can correspond to the volume of a healthy uterus at the same time in the postpartum period.

If a woman has a similar diagnostic picture on ultrasound and a general inflammation clinic, it is urgent to start specific antibiotic therapy. At the same time, the study of the uterus using ultrasound is repeated at least 2-3 times a week, which helps to control the course of the treatment process.

The use of this diagnostic method makes it possible to diagnose and prevent possible postpartum hemorrhage with a high probability. The cause of such an acute pathology may be the remains of the uterine membranes or placenta in the cavity after childbirth.

It should be noted that the first ultrasound after childbirth in 90% of cases is carried out for prophylactic purposes. However, if the specialist has any doubts about the health of the woman and the condition of the uterus, then within 1 to 2 weeks, a second diagnostic session is mandatory.

Indications for an unscheduled examination

Current practice recommends that all women in labor undergo ultrasound in the first week after birth in a maternity hospital. Re-examination in the absence of pathological processes in the female body is recommended 2-3 months after the first.

However, if a woman has certain health problems during this period, ultrasound can and should be carried out earlier than the specified period. You should consult a doctor in the following cases:

• If a young mother noticed that 1 - 2 weeks after birth, she had appeared from the genitals. This recommendation should be implemented immediately if these discharges are bloody.
• Any general manifestations of the inflammatory process in the pelvic area. This includes pain in the abdomen and pelvis, and.
• Any problems with .
• Severe bleeding from the vagina that cannot be stopped with the usual home remedies. A similar symptom can be the result of very serious disorders in the female genital area, including cancer.

Ultrasound after childbirth is one of the most effective methods for early diagnosis of various diseases of the uterus and other genital organs caused by childbirth.

Thanks to the use of this affordable and reliable way to recognize the presence of specific problems in young mothers, it was possible to significantly reduce the percentage of severe consequences of such diseases as acute postpartum uterine bleeding, and residual effects of a cesarean section.

Ultrasound, or echography, is a study of internal organs using sound waves. Waves reflected from the internal organs are recorded using special instruments and create images of anatomical details. In this case, ionizing radiation (X-ray) is not used. Normal ultrasound in adults serve as an indicator of the health of the genitourinary system in women.

For women, such a study is most often used to examine the uterus and ovaries before, after and during pregnancy in order to monitor the health of the organs, the development of the embryo or fetus. Ultrasound images are captured in real time so that they can show the movements of internal tissues in organs, such as the flow of blood in arteries and veins. The norms of the size of the uterus according to ultrasound are developed and calculated for any condition of a woman.

The uterus, its dimensions

The uterus is located in the small pelvis. Although it is usually a median structure, a lateral one is not uncommon. The broad ligaments of the uterus expand from the sides into the pelvic wall. They contain the fallopian tubes and blood vessels.

The norms of the size of the uterus according to ultrasound are approximately as follows. A normal adult uterus measures 7.0 to 9.0 cm (length), 4.5 to 6.0 cm (width), and 2.5 to 3.5 cm (depth). The last indicator is also called the anterior-posterior size.

During postmenopause, the uterus shrinks and the endometrium atrophies. The normal sizes of the uterus and ovaries by ultrasound have been developed and proven.

Norms of the size of the uterus according to ultrasound

When the ovaries undergo involution, there is an associated decrease in estrogen production. This leads to gradual atrophy and involution of the endometrium. In postmenopause, the average is noted as 3.2 +/- 0.5 mm.

Research usually reveals an inverse relationship between uterine size and time after menopause: uterine size and volume gradually decrease. The greatest changes occur during the first ten years after menopause, and then gradually.

In postmenopausal women, the normal size of the uterus according to ultrasound: 8.0 +/- 1.3 cm in length, 5.0 +/- 0.8 cm in width and 3.2 +/- 0.6 cm in depth (anteroposterior the size).

If there is no menstrual cycle, subsequent changes in tend not to be determined. If the patient is on hormone replacement therapy, then the size of the uterus, endometrium and cyclic changes may remain. Even the size of the uterus is approaching the indicators of the premenopausal state.

In general, estrogen therapy affects the postmenopausal endometrium in a manner similar to estrogen in the normal cycle. Conjugated estrogens have a proliferative effect. Progestogen therapy may cause the endometrium to respond in a manner similar to that of a normal secretory endometrium.

And when used together with exogenous estrogens, synthetic progestogens reproduce the characteristic biochemical and morphological changes in the secretory phase of the normal menstrual cycle.

The blood flow to the uterus also changes while taking hormone replacement therapy. The thickness of the endometrium almost doubles. For example, before treatment, the average thickness was 0.37 +/- 0.08 cm. After treatment, the values ​​became 0.68 +/- 0.13 cm.

In the study of postmenopausal women, one of the most important applications of ultrasound is the diagnosis and treatment of endometrial cancer. Such studies allow you to determine the normal size of the uterus and ovaries by ultrasound. And in general, intravaginal ultrasound surpasses the capabilities of transabdominal ultrasound for visualization of the myometrium and endometrium.

M-echo. What is it

When conducting a study, not only the size of the uterus is measured. According to ultrasound, the M-echo norm is also an important indicator. It reflects the development, condition of the endometrium and its readiness to receive a fertilized egg. It is measured in different phases of the cycle and has certain boundaries.

During menstruation, the endometrium appears as a thin echogenic strip 1-4 mm thick, but varies from 4 to 8 mm in the proliferative phase. In the secretory phase after ovulation, the endometrial glands are stimulated and the endometrium appears as a more uniform echogenic band 8 to 15 mm thick.

Norm indicator

We continue to consider such an important indicator as the size of the uterus according to ultrasound. What is the M-echo rate?

Intima thickness of 5 mm or less is fairly common in postmenopausal women and reliably rules out malignancy in women. However, endometrial thickness up to 8 mm can be found in postmenopausal women receiving hormone therapy. Consideration should be given to further diagnostic testing in postmenopausal women with an endometrial thickness greater than 8 mm to rule out endometrial cancer.

Rule out cancer

Sonographic features of postmenopausal endometrial cancer include:

• fluid-filled channel;
• thickened uterine cavity;
• enlarged uterus;
• damage to the uterus with a change in the echo pattern.

Even ultrasound already accurately shows the presence and degree of invasion of the myometrium. These studies have shown that the most accurate preoperative diagnosis may allow the right choice of therapy, possibly leading to improved outcomes.

If the thickness of the endometrium is 8 mm or less in patients with postmenopausal bleeding, then the correct diagnosis of endometrial cancer can be made by curettage. Therefore, postmenopausal endometrial thicknesses of 10 mm or more should be further evaluated by biopsy or curettage to rule out malignancy or hyperplasia.

Several investigators have demonstrated the usefulness of Doppler ultrasound in the diagnosis of endometrial cancer. Researchers attributed increased blood flow in the uterine artery to the suspicion of a tumor in patients with malignant diseases: abnormal blood flow can be detected in almost all cases of endometrial carcinoma, as well as With color Doppler, abnormal findings include the presence of irregular, thin and chaotically distributed vessels and an abnormal signal flow rate .

Why measure the cervix

Every pregnant woman is at risk of preterm labor, but most think it will never happen to them. When faced with this, they are reminded of prevention and additional research. The most accessible and harmless study is ultrasound, in which the doctor can make a diagnosis of threatening preterm birth.

Numerous studies have shown that an ultrasound scan of the cervix from approximately 20 to 24 weeks of gestation is a strong indicator of preterm labor. The length of the cervix can most accurately be measured using transvaginal ultrasound. If a woman is not pregnant, then the size of the cervix according to ultrasound (normal) is about 4 cm.

What is a shortened cervix?

It has been proven that during the 24 weeks of gestation, the average size of the cervix is ​​3.5 cm. If this figure is less than 2.2 cm, women face a 20 percent chance of preterm birth. And with a length of 1.5 cm or less, the risk of spontaneous preterm birth is almost 50 percent. The length is expected to decrease as

The size of the cervix by ultrasound (normal):

• at 16-20 weeks - 4.0-4.5 cm;
• at 24-28 weeks is 3.5-4.0 cm
• at 32-36 weeks - 3.0-3.5 cm.

Most doctors will prescribe a transabdominal ultrasound for a woman at around 20 weeks. If the length is less than 4 cm, a transvaginal ultrasound is done to get a more accurate measurement.

A shortened cervix between 20 and 24 weeks is a dangerous symptom.

With the help of transvaginal ultrasound, you can see both from above and below the cervix. In this case, it looks like a funnel. The widest part of the funnel is closest to the body of the uterus, and the narrowest part is located towards the vagina. When the cervix shortens even more, it will look like a "V" on the ultrasound.

Normally, the cervix is ​​shaped like a tube. More than 50 percent of pregnant women with pathology of this organ experience premature birth.

The size of the uterus on ultrasound

The norm during pregnancy depends on the gestational age. The program for calculating the duration of pregnancy is incorporated in sonographs according to the measurements of the sizes of individual organs of the fetus and uterus.

If we apply a comparison with fruits, then the size of the uterus according to ultrasound (normal in mm) will be as follows.

1. Before pregnancy, the uterus is about the size of an orange and is not defined.

2. At about 12 weeks of gestation, the uterus becomes the size of a grapefruit. If twins are born, the uterus will begin to grow faster.

3. At 13-26 weeks, the uterus grows to the size of a papaya. The bottom of the uterus is located over time from the womb to the navel.

4. Starting at 18-20 weeks, the doctor will measure the distance from the fundus of the uterus. This is the height of the fundus of the uterus. The size usually corresponds to the week of pregnancy.

If the size of the uterus matches the gestational age, then this is a sign that everything is going well. If the indicator is too large or too small, this may mean some kind of complication of pregnancy. Additional testing may be required. The doctor needs to know the size of the uterus by ultrasound. The norm during pregnancy of this indicator means that everything goes as it should.

5. During the third trimester, the uterus finishes growing and becomes the size of a watermelon. When the time comes for childbirth, the uterus is at the level of the lower part of the chest, and before childbirth it should fall lower into the pelvis.

postpartum period

What is the size of the uterus after childbirth? The norm for ultrasound corresponds to the duration of pregnancy. About a day or two after giving birth, the uterus will be about 18 weeks in size and shrink over the following days. If healing goes according to plan, then in a week the uterus will be the size of a 12-week gestation, and by the sixth week it should return to its normal size.

ovaries

The ovaries are usually located on either side of the uterus, although it is not uncommon to find them above or behind the uterus on examination. The ovary is most often located in front of the bifurcation of the vessels into the anterior and posterior branches. Good access is essential for successful visualization of the ovaries.

During postmenopause, the ovaries undergo changes characterized by a decrease in size and the absence of folliculogenesis. As such, reliable identification of the ovary in many cases cannot be made by demonstrating an ovarian cyst when the follicle is surrounded by parenchyma. Sometimes you have to resort to scanning along the route of the internal iliac vessels to find its location.

There is usually an inverse relationship between ovarian size and time since menopause: ovarian size progressively decreases over time. However, in patients receiving hormone therapy, no change in ovarian volume can be seen.

Size changes

Normally, after menopause in women, the size of the ovaries is 1.3 +/- 0.5 cm 3. There is no menstrual cycle at menopause, so changes in the blood supply to the ovary are usually not visible on examination in the normal post-menopausal period.

These cyclical changes, however, may be evident if the patient is on hormone replacement therapy. In fact, the blood flow pattern of a postmenopausal premenopausal ovary should direct the clinician to look for a history of hormone replacement therapy or cancerous changes. Ultrasound and Doppler can be of great help in differentiating between benign and malignant processes.

Dopplerography of the uterus for appendages should be performed:

• between 3-10 days of the menstrual cycle;
• between 3-10 days postmenopausal if the woman is on hormone replacement therapy;
• at any time in postmenopausal women without treatment.

Thus, not only during pregnancy, it is important to know the size of the uterus by ultrasound. The norm of this indicator, as well as the size of the ovaries, is an important sign of a woman's health in any period.

Use of the method in non-pregnant women

There are many reasons for having an ultrasound, including:

The norms of the size of the uterus according to ultrasound depend on how old the woman is, how many pregnancies and childbirth she had, how the menstrual function proceeds, etc. Now consider the difference in indicators by age.

Dimensions of an adult uterus

What is the normal size of the uterus on ultrasound in adults? About 7 centimeters long and 4 centimeters wide and thick, give or take a couple of centimeters. These are the data of many years of research.

These indicators are the norm for the size of the uterus according to ultrasound in adults. As a rule, there is an increase in size if the woman had childbirth. Fibroids can make these measurements very large, however, as can adenomyosis.

The ovaries are usually 2 to 3 centimeters in size. Of course, volumes increase if there is a large follicle or cyst.

Sizes before puberty

What is the size of the uterus on ultrasound in this case? The norm in the prepubertal period (before puberty) is about 3.5 cm in length, and an average thickness of 1 cm. Hormonal stimulation that occurs in leads to rapid growth and changes in the size of the uterus.

Dimensions after puberty

The normal length in this period is about 7.6 cm, the width is 4.5 cm. The average normal thickness is 3.0 cm.

Thus, the normal size of the uterus on ultrasound in adolescents with a normal menstrual cycle is only slightly different from the size of the uterus of an adult woman.

After menopause, the uterus tends to shrink in size, and the ovaries may end up being nothing more than remnants of tissue. This is so, since the normal size of the uterus and ovaries on ultrasound during menopause is significantly reduced.

Conclusion

So what are the averages?

• length - about 70;
• width - closer to 55;
• anterior-posterior size - 40 mm.

Large sizes are not always considered a pathology. But in this case, it is necessary to conduct a study to exclude fibromyoma, adenomyosis, malformations, pregnancy.