Complications of cesarean section: role of transperineal US

The pelvic area was prospectively examined with transabdominal and transperineal ultrasonography (US) in 22 patients referred for US evaluation for possible complications of cesarean section. The region of the uterine wound was seen with transabdominal US in all patients and with transperineal US in 20. The two in whom transperineal US did not reveal the lower uterus had undergone scanning with their bladders empty. Bladder flap hematomas were revealed with transabdominal US in 10 patients and with transperineal US in nine. Transabdominal and transperineal diagnoses regarding bladder flap hematoma were in agreement in all 19 patients who underwent transperineal US with a distended urinary bladder. With the transabdominal approach, subfascial hematomas were seen in nine patients, but none were revealed with the transperineal technique. In one patient, a hematoma in the space of Retzius was seen only with transperineal US. These findings indicate that transperineal US can complement transabdominal US in evaluation for complications of cesarean section.