To investigate the contrast-enhanced ultrasound (CEUS) manifestations of postpartum uterine necrosis and to assess their value in early diagnosis and treatment guidance.

A retrospective analysis was conducted on the clinical data of 8 patients with postpartum uterine necrosis confirmed by clinical findings or pathology who were admitted to Henan Provincial People's Hospital from January 2019 to October 2025. All patients underwent CEUS examination, and the findings were compared with surgical pathology or comprehensive clinical diagnostic results.

CEUS revealed central non-perfusion areas in all 8 patients, which were in sharp contrast to the rapid enhancement of the surrounding normal myometrium or serosa. Total or subtotal hysterectomy was performed in 4 patients, and the extent of necrosis delineated by CEUS was highly consistent with intraoperative findings and postoperative pathological results. In the remaining 4 patients, whose infections were well-controlled, conservative treatment was administered based on CEUS assessment and achieved favorable efficacy, thereby avoiding unnecessary hysterectomy.

CEUS can accurately delineate the extent of uterine necrosis at an early stage, which is of great significance in guiding individualized treatment planning, preventing treatment delays, and avoiding unnecessary hysterectomy.