puerperio

IMÁGENES EN ELPUERPERIO

DR ALLAN DAVILA TERREROS

PUERPERIO NORMAL

Periodo Temprano

(Primeras 2 sem)

Periodo Tardío

(Segunda 2 sem)

Eliminación loquios

(14-21días)

Involución uterina

ECOGRAFIA TC - IRM

METODOLOGIA ESTUDIO

Evaluación inicial

1) Suprapúbico:

(Primeras 2 sem).

2) Endovaginal

(Puerperio tardío).

Para casos más severos o de

mayor complejidad

HALLAZGOS NORMALES

Al inicio:

Útero alargado

Masas o material ecogénicas con componente sólido y/o líquido en cavidad endometrial.

Gas intrauterino

Intermedio(1-2sem):

Útero reducido

Escaso material ecogénico intrauterino con o sin gas

Tardío (> 14-21 d)

Tamaño uterino normal

Endometrio ecogénico lineal inactivo (hipoestrogenismo fisiológico)

UTERO PUERPERAL

NORMAL

CUANDO SE EVALUA POR IMAGENES

Fiebre persistente / refractaria

Hemorragia vaginal inmediata

/ tardía

Dolor pélvico / masa palpable

Endometritis

Retención tejido placentario

Atonía uterina

Trombosis vena ovárica

Abscesos / Hematomas extrauterinas

CT scan of the pelvis demonstrates an enlarged postpartum

uterus with an endometrial cavity expanded

by fluid, debris, and a moderate amount of air.

ENDOMETRITIS

RPCSagittal sonogram shows echogenic mass (arrowheads)

expanding endometrium with residual placental

calcifications (arrow)

RPC Calcifications. US image shows echogenic material

with posterior acoustic shadowing (arrow)

RPC

Valoración doppler, demostración

flujo arterial abundante con baja

resistencia

RPC. (a) US image shows echogenic material within the endometrial canal (arrows). (b) Color

Doppler US image (shown in black and white) demonstrates low-resistance arterial flow within

RPOC. Peak systolic velocity was

22 cm/sec.

TROMBOSIS VENA OVARICA

Sequential axial enhanced CT images show postpartum uterus

(U), enlarged heterogeneous ovary (arrow, A), dilated tortuous

right ovarian vein and partial thrombosis in pararenal inferior

vena cava (arrow)

Postpartum hemorrhage caused by uterine atony after

vaginal delivery.

Contrast-enhanced CT scans at level of uterine body show

focal contrast extravasation (arrows)

ATONIA UTERINA

ABCESOS PUERPERALES

Sagittal (a) and axial (b) contrast-enhanced CT scans demonstrate a

fluid collection with pockets of air (arrow in a, straight arrow in b)

extending from the surgical wound (curved arrow in b). The abscess is

distinct from the endometrial cavity (arrowhead).

Axial fat-suppressed T2-weighted MR images obtained at

the level of the fundus of the uterus (a) and the body of the

uterus (b) show multiple small, markedly hyperintense areas

(arrows) surrounded by slightly hyperintense regions

adjacent to the uterus.