Early puerperal vaginal ultrasonography (us) of the post cesarean uterus

OBJECTIVE: Early puerperal sepsis commonlv includes as a differential diagnosis retained products of conception. Because only limitée! data are available detailing the normal I'S characteristics of the uterus following cesarean deliveiv, this descriptive stiuh was undertaken in uncomplicated postoperative (postop) subjects. STUDY DESIGN: Vaginal probe I'S was performed between postop days 24 in 20 subjects. The following measurements were obtained: length, depth, and width of intrauterine ravitv, uterus, and bladder-flap hematoma. if présent. The US appearance of the intratiterine contents was also subjectivelv recorded. Demographic and laboratory data. C/S indication, antibiotic prophylaxis type, and any morbidities were recorded. Onl\ patients with normal postop courses were included in this study. All US evaluations were performed by the same 2 investigators. RESULTS: Mean age was 26.1 ±6.3 vrs, mean gestational age of 39.1 ± 3.7 wks. Prophylactic antibiotics were given to 44% of patients. In 95% of cases, the bladder flap was not surgically repaired. Preop hemoglobin and WBC count were 11.3 ±1.2 gm/dl and 10.7 ±4.5, respectivelv. Postop hemoglobin and WBC count were 9.9 ±1.5 gm/dl and 13.9 ±4.5, respectively. In 61% of rases, I'S demonstrated a combination of blood, clots and debris within the uterine cavity; in 39% the uterus appeared emptv. The uterine scar appeared intact in all patients. No bladder flap collection was noted in 44% of the patients. Measurements (mm ± one SD) Uterus Intrauterine Cavity Bladder Flap Hematoma Length 102.7 ±12.1 65.0 ±22.7 13.7 ±13.8 Width 60.5 ±14.8 21.4 ±22.2 9.0 ±9.5 Depth 70.6 ±13.4 28.8 ±23.0 13.2 ±13.8 CONCLUSION: It is common to identify debris within the uterine cavitv during the earlv puerperium. following an uncomplicated cesarean delivery. Small collections, in the bladder flap area, are also likeh to be seen if vaginal probe I'S is utilized. Therefore, in the septic patient, these US findings do not neressarilv signal a focus of infection requiring surgical intervention.