Abdominal Radiology

, Volume 42, Issue 5, pp 1543–1555 | Cite as

Imaging in the post-partum period: clinical challenges, normal findings, and common imaging pitfalls

  • Attor Al-Muzrakchi
  • Noorulhuda Jawad
  • Mary Crofton
  • Shahla Ahmed
  • Elizabeth Dick
  • Wladyslaw Gedroyc
  • Nishat BharwaniEmail author
Pictorial Essay


Complex physiological and biochemical changes occur in women during the post-partum period, many of which are incompletely understood. There are limited descriptions within the medical literature about expected imaging findings during this period and this review aims to illustrate ‘normal’ appearances following vaginal delivery and Cesarean section. We will also discuss some of the pertinent clinical challenges and imaging pitfalls encountered in assessing the post-partum female.


Post-partum Ultrasound Computed tomography Magnetic resonance imaging Cesarean section 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


  1. 1.
    Romem Y, Artal R (1985) C-reactive protein in pregnancy and in the postpartum period. Am J Obstet Gynecol 151(3):380–383CrossRefGoogle Scholar
  2. 2.
    Belo L, Santos-Silva A, Rocha S, et al. (2005) Fluctuations in C-reactive protein concentration and neutrophil activation during normal human pregnancy. Eur J Obstet Gynecol Reprod Biol 123(1):46–51CrossRefGoogle Scholar
  3. 3.
    Klajnbard A, Szecsi PB, Colov NP, et al. (2010) Laboratory reference intervals during pregnancy, delivery and the early postpartum period. Clin Chem Lab Med 48(2):237–248CrossRefGoogle Scholar
  4. 4.
    Epiney M, Boehlen F, Boulvain M, et al. (2005) D-dimer levels during delivery and the postpartum. J Thromb Haemost 3(2):268–271CrossRefGoogle Scholar
  5. 5.
    Murphy N, Broadhurst D, Khashan A, et al. (2014) Gestation-specific D-dimer reference ranges: a cross-sectional study. BJOG Int J Obstet Gynaecol. doi: 10.1111/1471-0528.12855 CrossRefGoogle Scholar
  6. 6.
    Morikawa M, Yamada T, Yamada T, et al. (2011) Changes in D-dimer levels after cesarean section in women with singleton and twin pregnancies. Thromb Res 128(4):e33–e38CrossRefGoogle Scholar
  7. 7.
    Dick E (1970) Imaging in the Postpartum period: normal findings, complications and challenges(ed) (eds). European Congress of Radiology 2015Google Scholar
  8. 8.
    Kopans DB, Kopans D (1998) Breast imaging. Philadelphia: Lippincott-RavenGoogle Scholar
  9. 9.
    Ronckers CM, Erdmann CA, Land CE (2005) Radiation and breast cancer: a review of current evidence. Breast Cancer Res 7(1):21–32CrossRefGoogle Scholar
  10. 10.
    Wang PI, Chong ST, Kielar AZ, et al. (2012) Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. Am J Roentgenol 198(4):778–784CrossRefGoogle Scholar
  11. 11.
    Webb JA, Thomsen HS, Morcos SK, MoCMSCoESoU Radiology (2005) The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15(6):1234–1240CrossRefGoogle Scholar
  12. 12.
    Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, et al. (2000) gadopentetate dimeglumine excretion into human breast milk during lactation 1. Radiology 216(2):555–558CrossRefGoogle Scholar
  13. 13.
    American College of Radiology (ACR). ACR manual on contrast media v9 2013. Accessed 20 Dec 2014
  14. 14.
    The Royal College of Radiologists (2010) (10)4 Standards for intravascular contrast agent administration to adult patients, 2nd edn. London: The Royal College of RadiologistsGoogle Scholar
  15. 15.
    Mulic-Lutvica A (2012) Postpartum ultrasound. Ultrasound Obstet Gynecol 6(1):76–92Google Scholar
  16. 16.
    Romano M, Cacciatore A, Giordano R, La Rosa B (2010) Postpartum period: three distinct but continuous phases. J prenat Med 4(2):22–25PubMedPubMedCentralGoogle Scholar
  17. 17.
    Negishi H, Kishida T, Yamada H, et al. (1999) Changes in uterine size after vaginal delivery and cesarean section determined by vaginal sonography in the puerperium. Arch Gynecol Obstet 263(1):13–16CrossRefGoogle Scholar
  18. 18.
    Witt K, Franzblau N (2016) Normal and abnormal puerperium. Emedicine website.
  19. 19.
    Williams JW (1931) Regeneration of the uterine mucosa after delivery, with especial reference to the placental site. Am J Obstet Gynecol 22(5):664–696CrossRefGoogle Scholar
  20. 20.
    Edwards A, Ellwood D (2000) Ultrasonographic evaluation of the postpartum uterus. Ultrasound Obstet Gynecol 16(7):640–643CrossRefGoogle Scholar
  21. 21.
    Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB Jr, Kamaya A (2013) Physiologic, histologic, and imaging features of retained products of conception. Radiographics 33(3):781–796CrossRefGoogle Scholar
  22. 22.
    Sadan O, Golan A, Girtler O, et al. (2004) Role of sonography in the diagnosis of retained products of conception. J Ultrasound Med 23(3):371–374CrossRefGoogle Scholar
  23. 23.
    Hull AD, Resnik R (2010) Placenta accreta and postpartum hemorrhage. Clin Obstet Gynecol 53(1):228–236CrossRefGoogle Scholar
  24. 24.
    Wachsberg RH, Kurtz AB (1992) Gas within the endometrial cavity at postpartum US: a normal finding after spontaneous vaginal delivery. Radiology 183(2):431–433CrossRefGoogle Scholar
  25. 25.
    Sierra A, Burrel M, Sebastia C, et al. (2012) Utility of multidetector CT in severe postpartum hemorrhage. Radiographics 32(5):1463–1481CrossRefGoogle Scholar
  26. 26.
    Pellerin M, Colau J, Rebibo G, Savey L (1999) Pelvic MRI: normal findings in the early post-partum period. J Radiol Paris 80:579–584Google Scholar
  27. 27.
    Koutsougeras G, Karamanidis D, Chimonis G, et al. (2002) Evaluation during early puerperium of the low transverse incision after cesarean section through vaginal ultrasonography. Clin Exp Obstet Gynecol 30(4):245–247Google Scholar
  28. 28.
    Baker M, Kay H, Mahony B, Cooper C, Bowie J (1988) Sonography of the low transverse incision, cesarean section: a prospective study. J Ultrasound Med 7(7):389–393CrossRefGoogle Scholar
  29. 29.
    Rodgers SK, Kirby CL, Smith RJ, Horrow MM (2012) Imaging after cesarean delivery: acute and chronic complications. Radiographics 32(6):1693–1712CrossRefGoogle Scholar
  30. 30.
    Paspulati RM, Dalal TA (2010) Imaging of complications following gynecologic surgery 1. Radiographics 30(3):625–642CrossRefGoogle Scholar
  31. 31.
    Leyendecker JR, Gorengaut V, Brown JJ (2004) MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period 1. Radiographics 24(5):1301–1316CrossRefGoogle Scholar
  32. 32.
    Fielding JR, Brown DL, Thurmond AS (2011) Gynecologic imaging: expert radiology series. Amsterdam: ElsevierGoogle Scholar
  33. 33.
    Auh YH, Rubenstein WA, Schneider M, et al. (1986) Extraperitoneal paravesical spaces: CT delineation with US correlation. Radiology 159(2):319–328CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Radiology, St Mary’s HospitalImperial College Healthcare NHS TrustLondonUK
  2. 2.Department of Obstetrics and Gynaecology, St Mary’s HospitalImperial College Healthcare NHS TrustLondonUK

Personalised recommendations