The puerperium represents a period of profound physiological and anatomical changes that aim to return to the pre-pregnancy state. As shown by the almost half maternal deaths reported related to this period, the correct diagnosis and treatment of any complication are of paramount importance. In this scenario, the ultrasonographic evaluation has a key role as a first-level tool to identify and diagnose any complication and to address the cause of any pathological sign and symptom. The ultrasound evaluation is able to identify or exclude retained products of conception or arteriovenous malformations in the case of postpartum hemorrhage. Moreover, ultrasound allows for identifying and monitoring post-surgical complications after cesarean section, such as postpartum hematomas or pelvic abscess. Although the key role of this diagnostic tool, the reported reliability and validity of ultrasounds in assessing the different complications are heterogeneous, and the limited specificity and sensitivity of different ultrasound appearances need to be taken into account. To address this issue, the knowledge of the normal ultrasonographic appearance of the genital tract during the physiological puerperal involution is the first step to achieve an accurate distinction between normal and abnormal development of puerperium.
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