Year: 2026
Type: article
Abstract: Objective of the review: to analyze modern literature (published within the last five years) regarding current understanding of uterine subinvolution (US) in the postpartum period, including its etiology, mechanisms of development, and diagnostic approaches. We also summarize contemporary data on the vascular component, ultrasound and morphological diagnostic methods, and differential diagnosis with other vascular and infectious conditions that may cause late postpartum hemorrhage.Materials and methods. We conducted a comprehensive literature search across the bibliographic databases Scopus, Web of Science, MEDLINE, Embase, Global Health, and the Cochrane Library. We included sources published between 2021 and 2026; primarily narrative reviews focused on US as pathology of the spiral arteries, morphological diagnostic methods, ultrasound criteria, Doppler findings, differential diagnosis, and treatment approaches.Analysis of the literature. Modern studies demonstrate that US accounts for approximately 25% of late postpartum hemorrhages and is primarily a vascular disorder characterized by persistently dilated, thin walled, partially thrombosed spiral arteries containing residual endovascular trophoblast. This condition correlates with delayed myometrial remodeling and is a major cause of secondary postpartum hemorrhage, frequently misdiagnosed as retained products of conception or endometritis. Doppler ultrasound (demonstrating a low resistance index and high peak systolic velocity of blood flow) and morphological immunohistochemical markers such as cytokeratin 7 (CK7) and human leukocyte antigen G (HLA G) are essential for differential diagnosis. Evidence suggests that hormonal imbalance, particularly prolonged progesterone dominance, may delay postpartum remodeling of the spiral arteries and myometrium. This hypothesis may guide future clinical research on US.Conclusions. US should be considered a distinct vascular myometrial disorder of the postpartum period. Accurate diagnosis requires a combination of Doppler ultrasound, morphological verification, and clinical assessment. Further research is needed to better understand this condition.
Source: Reproductive Endocrinology
Authors: V.F. Nahorna, R.H. Bichevska, T.Y. Moskalenko
Institution: Odessa National Medical University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223569367