Which ultrasound after cesarean is considered ideal? Dimensions of the uterus after childbirth

After the birth of a child, recovery processes occur in the female body. All organs reproductive system are undergoing changes. The uterus is very traumatized after childbirth.

The uterus looks like an inverted pear. It is a hollow organ that consists of smooth muscles. It stretches due to the interweaving of muscle fibers and the action of hormones during pregnancy.

The hollow organ consists of a body, which in the prenatal state is about 5 cm, and a cervix - 2.5 cm in size. When a child is born, the tissues stretch and grow along with the fetus.

Recovery (involution) female organs after childbirth is natural process. If the delivery was natural, the uterus recovers and shrinks within 2 months.

The postpartum period happens:

early – 2 hours after the birth of the placenta;
late – up to 8 weeks after delivery.

Scars on the uterus after childbirth - normal phenomenon. Severe damage located in the area where the placenta is attached. This zone contains the most thrombosed vessels.

Epithelization (regeneration of endometrial tissue) occurs 10–12 days after birth. And the scar at the placenta insertion site heals by the end of the first month.

The uterus after childbirth is a sterile organ. Over the course of 3–4 days, processes such as phagocytosis and proteolysis take place in the hollow organ. During them, bacteria located in the uterine cavity are dissolved with the help of phagocytes and proteolytic enzymes.

The first days after the birth of a child, the hollow organ is too mobile due to stretching and insufficient tone ligamentous apparatus. This is noticeable when the bladder or rectum is full. The tone is acquired in a month.

How long does the uterus contract after childbirth?

Contractions of the uterine cavity feel like contractions. In the first days after delivery, they do not have an aching character.

The release of the hormone oxytocin during breastfeeding causes muscle spasms. During contraction muscle tissue, blood and lymph vessels are compressed, and some dry out - become obliterated.

The tissue cells that appeared during pregnancy die and are resorbed, while the rest decrease in volume. This helps restore the uterus after childbirth.

Change in organ mass:

after childbirth – 1 kg;
after 7 days – 500 – 525 grams;
after 14 days – 325 – 330 grams;
at the end of the postpartum period – 50 – 65 grams.

To speed up contractions, immediately in the delivery room, after the birth of the placenta, ice or a cold heating pad is placed on the stomach.

Postpartum uterine parameters:

the length of the organ is 15–20 cm;
her cross dimension 12–13 cm;

Bottom hollow organ after the birth process, it drops sharply, not reaching the navel by 2.5 cm, and the body tightly touches the abdominal wall. The uterus has a dense structure and often shifts to the right.

Due to contractions, it drops by 1 cm every day. At the end of the first week, the bottom reaches the distance between the navel and the pubic area. Already on the 10th day the uterus is below the pubis.

The cervix recovers more slowly: 12 hours after birth, its diameter will be 5–6 cm. By the middle of the second week it closes internal os, and the external one is formed at the end of the second month after birth.

The pharynx is not restored to its original appearance, since the tissue fibers are too stretched. Based on this sign, a gynecologist can determine whether a woman has given birth or not.

Initially, the pharynx has a round hole. After childbirth, a transverse gap remains on it. The shape of the cervix changes: if previously it looked like a cone, now it looks like a cylinder. Gradually all organs return to normal.

Recovery after caesarean section

Since surgical delivery involves disruption of the integrity of the uterus, it recovers more slowly. Infections and complications can slow down contraction. Recovery of the uterus after childbirth may be slow due to large blood losses.

Atony and hypotension

The hollow organ needs recovery after childbirth; the uterus cannot always contract on its own. Some women experience this situation.

In these cases, medical intervention cannot be avoided. This condition is called uterine atony. If the contractions are very weak - hypotension.

Common causes of atony:

second birth;
first pregnancy;
multiple pregnancy; Read more about multiple pregnancy→
large weight and size of the child;
various complications;
trauma to the canals or appendages.

The bending of the uterus after childbirth or the pathology of its development may contribute to the absence of contractions.

How to speed up uterine contractions after childbirth?

The speed of recovery depends on the following factors:

hormonal background;
woman's age;
child parameters;
number of previous pregnancies;
type of labor activity;
polyhydramnios;
inflammation of the genital organs.

Nature has thought out the female body down to the smallest detail. Restoration of the hollow organ occurs according to the standard dimensions of 1–2 cm daily. But if minor deviations from the norm begin to be noticed, you can resort to accelerating the reduction process.

Restoring the uterus after childbirth involves the following steps:

If the uterine fundus is soft, then the uterus will contract more slowly. Effective method is a massage of the surface of the abdominal wall from the outside.
To shrink the organ after childbirth, a cold heating pad or ice is applied to the abdomen. Medications that stimulate spasms may be used.
Maintain genital hygiene. The penetration of infections and various complications affect the ability to contract.
Active walking.
Do not allow filling Bladder and rectum.
Lactation. At breastfeeding Oxytocin is released, causing uterine contractions. Breastfeeding mothers restore the uterus faster.
Postpartum exercises that stimulate contraction of the uterine muscles.

Restoration of the uterus must take place under the strict supervision of a physician. Any deviation from the norm is a pathology and requires surgical intervention.

Postpartum discharge

Blood in the uterus after childbirth is formed due to wounds on the surface. The discharge is called lochia. The secretion for 3-4 days is red. At this time, lochia has sweetish smell blood.

They consist of 20% fluid from the uterine glands, and the rest is unchanged blood. Restoration of the uterine mucous tissue begins immediately after delivery.

If the discharge continues longer than the specified period or has bad smell- Be sure to consult a doctor.

This may happen for the following reasons:

bending of the cervix;
weak contractions in the uterus;
blockage of the pharynx with blood clots.

This condition is dangerous, as it may indicate an inflammatory process. If lochia ends in the fifth week or lasts longer than the ninth, you need to consult a gynecologist.

Process flow without deviations:

Vessels burst in the cavity, as a result of which the bloody discharge has a bright red color for 2–3 days.
During the first 7 days, the remains of the placenta and atrophied endometrium come out - discharge with clots.
After 7 days, liquid lochia has a pinkish tint.
Mucus gradually comes out - the result of the activity of the fetus inside the womb. They stop within a week.
After a month and a half, the lochia disappears and spotting appears.

What complications may arise?

After the birth process, various complications can occur.

Postpartum hemorrhage

It can begin immediately after delivery. Bleeding is not accompanied by pain and can be very severe. Without surgical intervention, a woman's life may be at risk.

Causes of bleeding:

disturbances occurred during the separation of the placenta and membranes;
trauma during childbirth;
uterine contraction is impaired.

Medicines are used for treatment and donor blood. Due to the risk of bleeding, the woman is always left in the delivery room for several hours.

Subinvolution of the uterus

As a result of the delay postpartum discharge the organ contracts poorly. Often this disease appears on days 6–7: clots in the uterus after childbirth or part of the fetal membrane block the cervical canal.

Endometritis

Inflammation of the uterus is called endometritis. It appears due to infection of the cavity.

INthe occurrence may be due to the following factors:

difficult labor process;
the placenta separated incorrectly during childbirth;
diseases of the genital organs during pregnancy;
decreased immunity.

Symptoms of endometritis:

heat;
after childbirth the uterus hurts;
rotten smell of postpartum discharge.

To put accurate diagnosis, an ultrasound scan of the uterus is performed after childbirth. In case of endometritis, the contents of the cavity are removed, washed or scraped out. After surgery, antibiotics are prescribed.

Prolapse

It may happen that after childbirth the uterus prolapses. This occurs as a result of injury to muscle tissue pelvic floor. Women carrying a second child are often susceptible to this complication.

Normally, the uterus after childbirth is located in the navel area when the placenta comes out. The bottom drops 1–2 cm daily.

Any deviations from the norm are considered pathology. In severe forms, the uterus may prolapse into the vagina and come out after childbirth.

It is necessary to treat prolapse in a timely manner so as not to be at risk infectious infection, omissions internal organs urinary system. When the uterus prolapses sex life prohibited.

To reveal possible pathologies It is recommended to visit a gynecologist 6–9 weeks after birth. Even if you feel good, there are no painful sensations and discomfort.

Restoration of the uterus after childbirth

All women are interested in what the uterus looks like after childbirth. Its cavity decreases from 40 to 20 cm, and is restored by 1–2 cm daily. In order for contractions to be normal, it is necessary to periodically be examined by a gynecologist. There are many techniques for restoring the uterus.

Traditional medicine

Nettle has a good effect on uterine contractions. Three tablespoons of the plant are infused in 0.5 liters. boiling water Let it brew and cool. Drink 1/2 glass 3 times a day.

You can buy water pepper tincture at the pharmacy. It also promotes uterine contractions.

Flowers and grass of the white claret are used in a decoction and help restore the hollow organ. The decoction does not cause an increase in blood pressure. You can drink it for hypertension.

The plant helps with bleeding " shepherd's purse" You can use 3-4 tbsp of tea per day. spoons of herbs per 400 ml of boiling water.

Also with abundant bloody lochia Red geranium helps. Drink iced tea from 2 teaspoons of dry plant to 2 cups of boiling water. The liquid should sit overnight. Drink in small portions throughout the day.

May birch leaves help speed up postpartum cleansing. Three tablespoons of leaves are brewed in 600 ml of boiling water. Add a pinch of soda and drink 200 ml 3 times every day. The product is effective from the 12th day after the birth process.

Physical recovery methods

Feeding your baby releases oxytocin, which influences uterine contractions.

From the first day you can do light physical exercise – postpartum restorative gymnastics. Charging should be carried out in a well-ventilated area with optimal temperature from 18 to 20 degrees.

If pain is felt, physical exercise should be stopped or another set of activities should be chosen.

All comprehensive measures aimed at restoration female body, must be carried out within 10–12 weeks. It is recommended to go to the toilet before training. Exercise with full bladder, gynecologists do not advise. Exercise should also be done after breastfeeding.

If there were complications, surgical intervention or childbirth after uterine rupture, physical exercise must be coordinated with a gynecologist.

To avoid complications during childbirth, you should regularly visit a gynecologist during pregnancy. Recovery period Every woman experiences it differently, but if there are deviations from the norm, you need to consult a doctor.

Useful video on the topic: Why do you need to tie up your belly after childbirth and how to do it

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So yesterday we started talking about what happens to a woman in postpartum period and how can an ultrasound examination be used to identify early stages health problems and the formation of serious postpartum complications. This helps on initial stage conduct active treatment, which will allow a woman to save reproductive functions and not earn yourself chronic pathologies for life. So, what can maternity hospital specialists or antenatal clinic in the postpartum period?

Formation postpartum endometritis

Postpartum endometritis is called inflammation of the endometrium of the uterus (its inner mucous membrane). When conducting 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 remnants of placental tissue or fragments of fetal membranes. It is important for yourself 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 be able to 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 uterine contractions are required. If treatment is not started immediately after diagnosis, endometritis can progress to 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 is worth noting that today this pathology is thanks to timely diagnosis and prevention occurs infrequently, in approximately 2% of cases of women who give birth naturally.

Formation of postpartum hemorrhage

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

After the operation caesarean section

A cesarean 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; to carry it out, it is necessary to have certain indications - relative or absolute. And after a cesarean section, the uterus will return to its previous size much more slowly than the same process occurs during natural childbirth. The reasons for this include disruption of the structure of the muscle fiber in the area of the uterine wall due to the incision and subsequent suturing, which results in the formation of a scar on the uterus. During a cesarean section, the uterus acquires the size and shape of the uterus as it was before pregnancy only on the 10th day of the postpartum period.

In addition, the mere performance of a cesarean section on a woman in labor significantly increases the risks various kinds complications. Endometritis occurs more often after childbirth, the frequency of bleeding increases, and they can be external, blood pours out of the vagina, and internal bleeding with accumulation of blood in abdominal cavity. That is why ultrasonic methods research, as the simplest and most non-traumatic, plays a leading role in monitoring young mothers who gave birth surgically.

Usually an ultrasound examination of the uterus and reproductive organs for a woman who has given birth to a child by cesarean section, it is prescribed within a period of three to four days from the date of the operation. But sometimes, in some cases, as prescribed by the doctor, ultrasound examinations may be prescribed during the first few hours after the operation to exclude bleeding in the abdominal cavity or disruption 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 from women, especially with indications of abdominal pain, in the presence of poor blood tests, especially with sharp decline hemoglobin and hematocrit after surgery. An ultrasound examination can be carried out either through the anterior abdominal wall(transabdominal) and through the vagina with a vaginal sensor.

An ultrasound evaluates approximately the same parameters as during a normal natural birth, but in addition, a mandatory examination of the scar in the uterine area 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 sutures of the uterus. The healing of sutures during a cesarean section does not always occur smoothly; in such cases, ultrasound helps in diagnosing hematomas (blood accumulations) in the area of the surgical scar, and also helps in monitoring the size and size, location of the hematomas, and determines the choice of treatment method.

Ultrasound for monitoring of detected pathology is carried out repeatedly, as prescribed by a doctor, to assess the dynamics of the process and the effectiveness of treatment. If the dynamics are positive and there is no danger to the woman’s health, she is discharged home from the maternity hospital under the supervision of a doctor at the antenatal clinic. When performing an ultrasound, women after childbirth, be it a natural birth or a cesarean section, are required to 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 - in normal conditions they should be missing. In addition, it is important to assess the condition of the uterine veins and surrounding tissue

After leaving the hospital

If you did not have an ultrasound for some reason while still in the maternity hospital, it is necessary mandatory spend in the antenatal clinic along with a visit to the gynecologist during the first week after discharge from the hospital to home. It is also important to determine the need for an ultrasound scan if this study was carried out in the maternity hospital and there were any manipulations or therapeutic effects. Thus, all women who are at risk for postpartum complications, as well as those who had complications during childbirth, must undergo an ultrasound of the uterus five to eight days after discharge from the hospital. Carrying out an ultrasound scan at these times will help prevent late complications or relapses of endometritis. The risk group is multiple pregnancy and polyhydramnios, prolonged labor and blood loss during childbirth, a long anhydrous interval, manual control of the separation of the placenta.

If, according to the results of the 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 examination are necessary for monitoring after discharge from the maternity hospital. You definitely need to go to the gynecologist in the first month after giving birth, and the doctor will determine the need for an ultrasound after examination; if no abnormalities are found, your next visit to the doctor awaits you six months after the birth.

To whom and when is ultrasound indicated?

Indications for immediate ultrasound after childbirth may include:

Increased bleeding from the genital tract, which may indicate the presence of placental remnants in the uterine cavity, 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 immediate treatment;
- painful and discomfort in the lower abdomen, in the area of the cesarean section scar, which may indicate failure of the suture or its divergence.

The postpartum period is a period of time during which a woman who has given birth experiences 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 placenta is separated and lasts up to 6 weeks.

Immediately after the birth of the placenta, the uterus decreases significantly in size. Its bottom ( top part) at this moment is at the level of the navel. The day after childbirth, the fundus of the uterus drops slightly 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 8th–9th day, the fundus of the uterus can still be felt at the level of the womb or slightly above it. An important indicator is a 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 discharge from the genital tract (lochia). The discharge in the first 2-3 days after birth looks like bright red blood, from the 3-4th day until the end of the first week it is paler, bloody, and then the lochia becomes even lighter, acquires a yellowish tint, and becomes mucous. At 5–6 weeks of the postpartum period, bleeding stops completely and is of the same nature as before pregnancy.

Ultrasound after childbirth during this period, helps the doctor to objectively assess the condition of the woman’s reproductive system after childbirth and, if necessary, carry out timely treatment certain complications.

After natural childbirth

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

At normal course postpartum period Ultrasound of the uterus Most often carried out on the 2-3rd day after birth. Usually the transabdominal method is 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 sensor. In some situations, if a more detailed examination of the cervix is necessary, vaginal method ultrasound diagnostics.

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 liquid blood or blood clots, which at this time may be located in its upper part, and by the 5th–7th day they are displaced into lower sections. An ultrasound diagnostic doctor can see changes in the uterine cavity - its excessive expansion, the presence of membranes, remnants in it placental tissue, excessive accumulation of liquid blood or blood clots, all of which help prevent serious complications postpartum period. The size of the uterus is also assessed, and then they are compared with 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 its normal size. It could be physiological state, for example, after multiple pregnancy, birth of a large fetus, polyhydramnios, in multiparous women. In other cases, such a discrepancy is considered pathological and is called uterine subinvolution, i.e. slowing it down reverse development. In such situations Ultrasound after childbirth allows you to identify the cause of deviations from the norm and helps the obstetrician-gynecologist determine further tactics of action. This complication occurs in approximately 1.5% of women who give birth.

If the uterus contracts insufficiently during the first 5 days, the woman’s condition is monitored and drug treatment- drugs that contract the uterus are prescribed, as well as antispasmodics that relax the muscles of the cervix to ensure a complete outflow of contents. If ultrasound shows in the uterine cavity a large number of large blood clots, it may be necessary to vacuum aspiration (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 may enter the uterus and develop severe complication postpartum period - endometritis (inflammation of the inner lining of the uterus). Therefore, timely Ultrasound after childbirth can significantly reduce the risk of developing this disease.

Postpartum endometritis. Ultrasonic signs Endometritis is a decrease in the tone of the uterus, expansion of the cavity, accumulation of gas, remnants of placental tissue or fetal membranes. It is important to understand that treatment of endometritis must begin as early as possible. The woman is prescribed bed rest, a course of antibiotics and uterine contractions. If treatment is not started in time, endometritis develops into severe form, which may require removal of the uterus and even threaten the woman’s life. But it is important to note that this disease is quite rare - in approximately 2% of women after vaginal childbirth. birth canal.

Postpartum hemorrhage. Ultrasound on the 2-3rd day after birth allows you to prevent very serious complications of the postpartum period - bleeding, which can begin suddenly and can be very heavy. They are often caused by remnants of placental tissue or membranes in the uterine cavity, which can be easily diagnosed by ultrasound. In such cases, to stop the bleeding, it is necessary to perform curettage and remove the remaining placental tissue.

If at the first Ultrasound after childbirth If any pathology is identified, ultrasound is performed several more times during the treatment process and after its completion in order to evaluate the effectiveness of therapy. And only in case of good results control study the young mother can be discharged home under the supervision of a doctor at the antenatal clinic.

After caesarean section

After a caesarean section, the uterus returns to its size more slowly than after a vaginal birth. This is due to a disruption in the structure of the muscle fibers of the uterine wall due to the incision made during surgery. She takes on the same size and shape as before pregnancy only by the 10th day of the postpartum period.

After a cesarean section, a woman in labor has a significantly increased risk of various complications– postpartum endometritis occurs more often and is more severe (6–11% of cases), the frequency of bleeding is higher (about 5%), both externally - from the vagina, and internally - into the abdominal cavity. Therefore, ultrasound plays an invaluable role in monitoring such young mothers.

In most cases, ultrasound examination of the organs of the reproductive system is performed on women in labor on the 3rd–4th day after surgery. But Ultrasound after childbirth may be prescribed within a few hours after the end of the operation to prevent bleeding into the abdominal cavity and disruption of the integrity of the sutures on the uterus. A study is carried out if a woman complains of intense abdominal pain or if blood tests are unsuccessful, in particular, if the hemoglobin level decreases after surgery.

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

Using ultrasound, the same parameters are assessed as after natural childbirth. But, in addition to this, there is also mandatory inspection postoperative scar on the uterus. Often, deviations in his condition indicate the development of certain complications. For example, a specific ultrasound sign of developing postpartum endometritis after cesarean section is swelling of the sutures on the uterus.

Unfortunately, stitches do not always heal well after surgery. In these cases, ultrasound helps to diagnose hematomas (collections of blood) 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 condition over time. After reaching positive results treatment, the young mother is discharged home under the supervision of a doctor at the antenatal clinic.

It is mandatory that ultrasound in women after childbirth (natural and after cesarean section) also evaluates the condition of the ovaries, the presence of fluid and blood clots in the abdominal cavity, in the 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 performed before discharge from the maternity hospital, then it is necessary to visit a gynecologist at the antenatal clinic within the first week after returning home and determine the need for this study.

All postpartum women included in the group high risk on the development of postpartum complications, and anyone who experienced complications immediately after childbirth is strongly recommended to repeat an ultrasound of the uterus 5–8 days after discharge from the hospital. Research conducted within this time frame will help prevent late complications or their repetitions. The risk group includes women with multiple pregnancy, polyhydramnios, protracted labor, large blood loss during childbirth, long intervals between effusions amniotic fluid and the birth of a baby, manual release placenta.

However, even if during the ultrasound in the maternity hospital everything was in order and upon discharge the woman was not bothered by anything, we must remember that in late dates complications may arise during the postpartum period. Therefore, a young mother is recommended to consult a gynecologist about a month after giving birth, and at the appointment the doctor will determine the need for an ultrasound. If no abnormalities are detected, then the next visit to the doctor and a preventive ultrasound should be planned in about 6 months.

Indications for ultrasound

Indications for urgent appeal see a doctor and have a pelvic ultrasound performed bloody discharge from the genital tract, which may indicate retention of a portion of the placenta in the uterine cavity - the so-called placental polyp (a growth on the wall of the uterus from placental tissue).

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

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

Also deserve close attention painful sensations in the lower abdomen, in the area of the suture after cesarean section and the appearance of discharge from it. Such manifestations can be observed when the suture is defective or diverges, which may require additional surgical treatment.

Collapse

Ultrasound examination is a mandatory, and often the main, type of diagnosis in gynecology. It should be carried out not only according to indications, but also prophylactically. For this reason, such a study is prescribed to almost all gynecological patients. Why an ultrasound of the uterus is performed after childbirth, what information it contains, and what questions it gives answers to, will be discussed below.

Indications

There is an opinion that ultrasound is a mandatory (or very desirable) type of examination at the gestation stage, which is why it is prescribed to expectant mothers regularly. At this stage, it helps not only to determine the sex of the fetus, but also to notice possible pathologies in its development and/or gestation in general. However, this procedure is no less necessary at the postpartum stage. In what cases is it recommended to carry it out? postpartum period unscheduled and according to indications?

One control ultrasound examination is always carried out, its exact date is prescribed by the doctor. Usually, it is recommended to do it a few days after birth;
The presence after childbirth of strong or long-term pain, in which the presence of pathological causes can be suspected;
The presence of bleeding that is too heavy or longer than during the normal course of the recovery period;
Insufficient, too scanty bleeding, which can cause the formation of blood clots in the uterus;
There is any discharge from the suture after a cesarean section;
Uncharacteristic discharge from the genitals is observed, having a yellowish or greenish color, impurities of pus, etc.;
Body temperature rises to 38 degrees, there are signs of intoxication, inflammatory process and so on.

If this or any other symptom that confuses the patient and the doctor is present, an urgent unscheduled ultrasound examination, which allows you to determine the presence possible deviations and anomalies.

Contraindications

Although ultrasound is generally safe and simple procedure, it is not always possible and not for all patients. In some cases, there may be contraindications to its implementation, especially after childbirth. These include restrictions such as:

Conducting a transvaginal examination due to significant damage to the cervix and sometimes the vagina. This contraindication especially applies to early dates after childbirth - in this case, the study is normally carried out using the transabdominal method. Transvaginal can be prescribed only sometimes, in cases where it is necessary to carefully examine the cervix in order to diagnose any condition;
After a cesarean section, performing the transabdominal method can be difficult due to the fact that there is a scar whose density is changed. As a result, it is not possible to build an objective picture;
If there are any other large scars in the area where the sensor is applied, the peritoneum can also become an obstacle to building an objective picture;
If the patient is obese, the fat layer prevents informative diagnosis.

Ultrasound of the uterus after cesarean section can only be performed transvaginally, since there is no possibility of informative research using the transabdominal method. In this case, the cervix is almost undamaged, therefore there are no contraindications to transvaginal examination.

Preparation

How to prepare for such a study? This largely depends on the method by which it will be carried out. If we're talking about about the transvaginal method, no preparation is required at all. All the patient needs to do is take a condom with her to the procedure, which is placed on the sensor for hygiene purposes. Also, in some cases it is necessary to take a disposable sheet and/or towel with you.

For transabdominal examination, the preparation is somewhat different. Such a study is carried out strictly under the condition of a full bladder, since only in this case the uterus occupies a position in which its study will be as informative as possible. Before the test, it is better not to urinate for at least four hours. Also, sometimes you need to take a disposable diaper or sheet and/or towel with you.

When to do it?

After childbirth, such a study is prescribed in different terms, depending on how exactly they took place. If they pass naturally and without complications, then a planned examination is scheduled 2-3 days after them. If any complications occurred during the process, for example, there is a suspicion of uterine rupture, then an ultrasound is performed in the first two hours after completion of the process, in order to timely detect bleeding, etc.

If a caesarean section was performed, the examination is carried out in the first hours after it. This is due to the fact that any complications could arise during such an operation. A timely ultrasound allows one to examine the nature of the sutures, the level of damage to the organ, its condition, and exclude bleeding and endometritis.

If available in birth process or during the recovery period after childbirth, any symptoms that have pathological character, and a concern for the patient and the doctor, the study is carried out immediately, regardless of how much time has passed after birth.

Methodology

The procedure is as simple as possible and does not differ significantly from how ultrasound was done before pregnancy. At abdominal method During the examination, the patient is placed on a couch and a conductive gel is applied to her skin. The ultrasound specialist moves the sensor over the abdomen, resulting in a corresponding image on the display.

With the transvaginal method, the patient is in gynecological chair. The sensor, which is covered with a condom and lubricated with conductive gel, is placed in the vagina. Both the chair and the couch should be covered with disposable sheets.

Features after cesarean section

How is an ultrasound of the uterus done after childbirth if there was a cesarean section? The main feature of ultrasound examination after cesarean section is that it can be performed exclusively transvaginally.

Transabdominal method for a long time after such an operation remains uninformative. In addition, the peculiarity is that such a study is planned to be carried out in minimum terms, that is, as soon as possible after childbirth. This helps prevent the development pathological process. Indications for an urgent ultrasound after a cesarean section are swelling and redness of the suture, discharge from the suture of an unclear nature, bleeding from the suture, and its pain.

What does an ultrasound show?

On ultrasound, you can notice a change in the shape and size of the uterus, the presence mechanical damage and neoplasms in it, the presence of any liquid discharge in its cavity. Processes associated with the endometrium are also visible, and indirect manifestations of the inflammatory process can be detected.

Norms

IN in good condition When the recovery process goes as it should, during routine examination, significant reductions in the volume and dimensions of the uterus should be observed. A change in the shape of the uterus should also be noted - if on the third day it is round, then on the fifth it is oval, and on the seventh it is normal pear-shaped, the same as it was before childbirth.

In this case, the endometrium, although it changes its thickness (relatively normal), is more or less homogeneous. There are no fluids or bloody discharge in the organ cavity. No perforations or significant injuries to the walls were found. The cervix gradually shortens, narrows and closes.

Deviations

Deviations are varied. These include a discrepancy between the size of the uterus and the period elapsed after pregnancy, changes in its shape, and any changes in the endometrium. The most unpleasant deviations are damage and perforation. It is also quite difficult to treat the presence of blood or any other discharge in the uterus. Signs of the inflammatory process may also appear on ultrasound.

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Questions and answers on: ultrasound of the suture after cesarean section

2014-10-10 06:46:00

Svetlana asks:

After physical exercise(pumped up my abs) yesterday I felt pain in the suture area after a caesarean section (transverse suture). Shvu is already 27 years old. And today they just slashed me like a knife, also after the exercise. I can’t strain or bend over. I thought the seam inside had come apart. What could an ultrasound show as the cause?

Answers Bosyak Yulia Vasilievna:

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

2015-02-21 20:50:18

Maria asks:

I have had three caesarean sections. The last one was 11 months ago. I recently had an ultrasound diagnosis (thinning of the myometrium in the area of the scar after cesarean section, adenomyosis and adhesions of the pelvic peritoneum) the scar on the uterus is thinned to 1.9 mm, under the thinning the uterine cavity is expanded to 6.3 mm over a length of 5.8 mm. There is abdominal pain in the suture area. The question is, can a seam rip? And what does this mean? Our gynecologists said that there was nothing to worry about.

2012-01-22 22:27:19

Elya asks:

Hello, I have a problem after a cesarean section. On the third day after the operation, the temperature jumped significantly, they could not determine the cause for a long time, it turned out that a hematoma had formed inside, which was opened. Three years have passed, a little higher postoperative suture a compaction of 13 mm in size was formed, the pain was localized in one place (at the site of the compaction) especially during menstruation. I did an ultrasound and didn’t really say anything, in this place the doctor noted a reduced echogenic zone. What is the likelihood of endometriosis of a scar or keloid? Which additional examination need to undergo it (I'm afraid of the inevitability of laparoscopy)?

Answers Wild Nadezhda Ivanovna:

You may indeed have endometriosis. For diagnosis, observation and dynamic ultrasound are required. The progression of endometriosis is stopped. Combined oral contraceptives(KOKi). You need to do an ultrasound immediately after your period and on the eve of your period. And it will be possible to say whether you have endometriosis or not.

2012-12-03 17:07:29

Periwinkle asks:

Hello, I had a caesarean section, the operation was successful and a healthy girl was born. In the hospital, before discharge, they didn’t examine me in the chair, they didn’t do an ultrasound, they didn’t take blood, they said there was no evidence. A day after discharge, aches all over my body began, then the temperature rose to 38.3 degrees. I arrived at the center where I gave birth, the doctor examined me and said that the uterus had closed ahead of schedule, she herself opened the cervix, prescribed physical therapy. solution, oxytocin, cefazolin 2 g. intravenously. My question is the following: was it possible to determine earlier closure of the cervix in a hospital setting? I only had discharge for 3 days after the operation, but the doctors did not ask me about the discharge; they only looked at the suture and touched my stomach.

Answers Wild Nadezhda Ivanovna:

According to the new orders, examinations on the chair are carried out strictly according to indications. It is impossible to predict how the sh/m will behave. It has great importance frequency of feeding the baby. The more often you feed, the better the uterus contracts and pushes lochia out of the uterus.

2012-03-09 20:08:22

Svetlana asks:

I'm 43, I had three births and 6 abortions as well. ectopic pregnancy last birth 5 years ago now I became pregnant, my husband and I will give birth, tell me can I ask the doctor for a planned cesarean section because I’m afraid to give birth at this age, my mother gave birth at 41, the child died during childbirth, I have no complaints about my health, but I was in a previous pregnancy 5 years ago atrial fibrillation 156 beats they did an ultrasound of the heart, there were changes in the myocardium, but the birth went more or less, not counting the fact that the cervix was opened manually, since after the ectopic it opened weakly and one-sidedly from the side of the suture, I don’t want to risk either myself or the child, is a cesarean section possible in my case, thanks for the answer

Answers Medical consultant of the website portal:

Hello Svetlana! You can ask your doctor for a planned cesarean section delivery, but consider this. Caesarean section is abdominal surgery, with the use of anesthesia or epidural anesthesia, a large load on the woman’s body, the risk of various complications (bleeding, infection), relatively severe postoperative period. Pre-existing cardiac problems can affect the course of surgery much more than the course of a natural birth. In addition, you are a woman who has already given birth three times - the fourth birth should not pose any particular difficulty or problem for you. Therefore, asking for an operation for you is not entirely correct solution. Discuss the situation with your doctor, with your husband, think for yourself (carefully) - and you will understand that natural childbirth in the absence of indications for cesarean 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 I’m pregnant now, I’m 28 weeks pregnant. This is my second pregnancy, my first pregnancy was almost 4 years ago in March 2008. it ended with an emergency caesarean section (they pierced my bladder, although one might say there were no contractions, after that the contractions started, lasted all night, in the morning I was told that the baby would not descend, I needed a caesarean section, because I had to be without water for a long time... that’s all with the baby ok, 4160 kg. but I lost a lot of blood during the operation, I felt very bad... the thought that I will have to go through all this again simply haunts me. My dream is to give birth on my own, but in our small town the doctors override my desire chuckle, calm down, and get ready for a cesarean! I don’t want to!!! I don’t want to suffer like this anymore after the operation, I still want a lot of children! There have been no abortions or miscarriages. I read a lot about natural childbirth after a cesarean, please answer, I beg you, is it possible Should I think about natural childbirth? The suture is vertical. Maybe you need to send some tests? Or ultrasound results. So you can at least guess if I have a chance!? You are my hope PLEASE ADVICE WHAT SHOULD I DO???!!! THANK YOU SO MUCH in advance FOR YOUR ATTENTION AND UNDERSTANDING! I'M REALLY WAITING FOR AN ANSWER... OLGA 24 years old, Republic of Sakha (Yakutia) Lensk

Answers Tovstolytkina Natalia Petrovna:

Hello Olga. It is now quite common to have a vaginal birth after a cesarean section. At the same time, there are clear contraindications for such childbirth, one of them is the failure of the uterine scar, which can be reliably determined in the first stage of labor. In addition, if you again have big baby(more than 4 kg), then very Great chance at vaginal birth rupture of the uterus along an old scar. I think that the incision of your uterus was made transversely, only the skin was sewn up with a vertical suture, otherwise vaginal delivery is contraindicated. If there are also no other indications for caesarean section (which may be the case) 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 performed a caesarean section, arguing that I had narrow pelvis And large fruit(3800). The recovery seemed to go well. In 2009 I became pregnant again, the doctors were only inclined to have an operation. The pregnancy proceeded normally, under constant medical supervision. I rented it out necessary tests I did an ultrasound on time. During the operation problems began. Firstly, the anesthesia had a bad effect on me; I “woke up” several times, so to speak, and heard the doctor’s voice and his nervousness. Then the bleeding started. The placenta was attached to the front wall of the uterus, and the doctor could not tear it off. The operation lasted more than two hours. As the doctor later told me, she already wanted to remove everything for me, since new lesions were constantly appearing. She put in a lot of stitches. After this operation I recovered within six months. And despite all the difficulties we have experienced, my husband and I would like to have another baby. Please tell me, is this possible? Where should we start? Thank you