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Postpartum ultrasound in women with postpartum endometritis, after cesarean section and after manual evacuation of the placenta
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrisk forskning/Axelsson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. (Obstetrisk forskning/Axelsson)
2007 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 2, 210-217 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To measure anteroposterior (AP) diameters, and to describe qualitative findings of the uterus and the uterine cavity in women with postpartum endometritis, after caesarean section (CS) and after manual evacuation of the placenta, and to compare these women with those in a normal puerperium. Methods. A prospective, descriptive, observational study of 103 postpartum women was conducted. Fifty-five women had clinical symptoms of postpartum endometritis, 28 had undergone CS, and 20 had manual placental evacuation. Ultrasound examinations were scheduled for days 1, 3, 7, 14, 28 and 56 postpartum. Women with endometritis underwent their first examination on the day they presented with clinical symptoms. Results. The AP diameters of the uterus and uterine cavity in all three groups overlapped considerably with the reference values. On day 56 postpartum, the uterus had achieved the same dimensions as found in our reference population. Compared with the reference group, during early puerperium, an empty cavity was less common among women with the three study conditions, and gas was present more often after CS and after manual evacuation of the placenta. An anteverted position of the uterus was less common among women with endometritis on day 14 and 28 postpartum, and among women delivered by CS on days 7, 14 and 28 postpartum. The incision site in the lower uterine segment was visible after CS. Conclusion. The ultrasonic findings in women with postpartum endometritis, after CS and after manual evacuation of the placenta, do not differ substantially from those during an uncomplicated puerperium. A delayed uterine involution process might explain the slight morphological differences observed.

Place, publisher, year, edition, pages
2007. Vol. 86, no 2, 210-217 p.
Keyword [en]
Ultrasound, puerperium, ceasarean section, endometritis, manual evacuation of the placenta
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95793DOI: 10.1080/00016340601124086ISI: 000244922700014PubMedID: 17364285OAI: oai:DiVA.org:uu-95793DiVA: diva2:170135
Available from: 2007-04-19 Created: 2007-04-19 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Postpartum Ultrasound
Open this publication in new window or tab >>Postpartum Ultrasound
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Postpartum Ultraljud
Abstract [en]

This study was undertaken to investigate the involutional changes of the uterus and uterine cavity by ultrasound (US), gray-scale and Doppler, after normal delivery, and to compare with the corresponding findings from women with puerperal complications, particularly retained placental tissue (RPT). The overall design was exploratory and prospective, with the use of descriptive statistics for analysis.

Forty-two women with uncomplicated vaginal term delivery were examined on post-partum days 1, 3, 7, 14, 28 and 56. The AP diameters of the uterus and uterine cavity and morphological findings were recorded. The maximum AP diameters of the uterus and uterine cavity diminished from 92.0 mm on day 1 to 38.9 mm at day 56 and from 15.8 mm at day 1 to 4.0 mm at day 56, respectively. The uterus was most often empty in the early and late puerperium while a mixed echo pattern over the whole cavity was found during mid puerperium (I).

Seventy-nine women with secondary post partum hemorrhage (SPH) were examined on the day they presented with clinical symptoms. US revealed an echogenic mass in the uterine cavity in 17 of 18 patients treated surgically and histology confirmed placental tissue in 14 of these. Sixty-one patients with either an empty cavity or mixed echo pattern had an uneventful puerperal course after conservative treatment (II).

AP diameters and morphological findings for 55 women with endometritis, 28 after caesarean section and 20 after manual evacuation of the placenta overlapped extensively with normal references (III).

The physiological vascular involution studied in 45 women after normal delivery showed that PI and RI indices did not change significantly until day 28 postpartum. The presence of at least one uterine artery notch was found in 13.3% of the women at day 1 and in 90.6% at day 56 postpartum (IV).

PI and RI values were measured and compared with reference values in 20 women with clinical suspicion of RPT who were to undergo surgical evacuation. Mean resistance indices were below the 10th percentile for eight of these 20 women, but overlapping was considerable. Doppler US has limited value as a diagnostic tool for RPT. The absence of a hyper-vascular area in the myometrium does not exclude RPT but an echogenic mass in the cavity is a sign of RPT (V).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 254
Keyword
Medicine, Postpartum ultrasound, Uterine artery Doppler, Retained placental tissue, Secondary postpartum hemorrhage, Puerperium, Endometritis postpartum, Cesarean section, Medicin
Identifiers
urn:nbn:se:uu:diva-7830 (URN)978-91-554-6873-6 (ISBN)
Public defence
2007-05-11, Rosénsalen, Institution för kvinnors och barns hälsa, Akademiska sjukhuset Ingång 95, Uppsala, 09:15
Opponent
Supervisors
Available from: 2007-04-19 Created: 2007-04-19Bibliographically approved

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Mulic-Lutvica, AjlanaAxelsson, Ove

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