ObjectivesTo evaluate the sonographic appearance of the uterus after a recent pregnancy, with special attention to the occurrence of placental rests, hyperechogenic lesions, and areas of enhanced vascularity.Patients and methodsCross‐sectional observational study on 239 consecutive women presenting at follow‐up visit after pregnancy. The uterus was evaluated using ultrasound with color Doppler. In case of placental rests, blood was sampled. When indicated a D & C was performed.ResultsHyperechogenic areas were seen in 11.3%, mostly spots (85.2%) localized in the (sub)endometrial region. In 4.6% placental rests were evidenced. In these cases blood sampling revealed βHCG levels below 30 mIU/ml in 64%; serological infection parameters and hemoglobin concentration were within normal range. In 5% of women areas of enhanced vascularity were detected on color Doppler. Most cases were focal areas of one or more vessels perfusing retained placental tissue. There were 2 cases of placenta accreta. In 3 patients abnormal vascularity extended over the whole of the myometrium.Conclusions(1) (Sub)endometrial echogenic spots are common in primigravidas without a history of curettage. (2) Serology proved to be of little help in the diagnosis of retained gestational products. (3) Areas of enhanced vascularity of the uterus can be devised in 3 groups: focal vascular pedicle of a placental rest, placenta accreta, and areas of abnormal enhanced vascularity over the whole thickness of the myometrium.