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Uterine artery Doppler ultrasound in postpartum women with retained placental tissue
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2009 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 6, 724-728 p.Article in journal (Refereed) Published
Abstract [en]

We measured prospectively uterine artery Doppler flow resistance   indices and looked for hyper-vascular areas in 20 patients who were to undergo surgical evacuation due to clinical and ultrasound-based suspicion of retained placental tissue (RPT). We compared these   findings with those of the normal puerperium. All 20 patients underwent surgical procedures. Placental tissue was histologically confirmed in 19 patients. Mean pulsatility and mean resistance values were below the 10th percentile for eight and seven women, respectively, but   overlapping was extensive. A hyper-vascular area was observed in 12   patients with histological confirmation. In eight cases, six of them   with histological confirmation, no hyper-vascular area was observed.   Although RPT is associated with lower resistance indices in the uterine   arteries, this knowledge has limited value as a diagnostic tool for   RPT. Absence of a hyper-vascular area in the myometrium does not exclude RPT, but its presence is common finding associated with RPT and should not be misinterpreted as an arterio-vascular malformation.

Place, publisher, year, edition, pages
2009. Vol. 88, no 6, 724-728 p.
Keyword [en]
Pulsed and color Doppler, ultrasound, uterine artery resistance indices, retained placental tissue, secondary postpartum hemorrhage
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95795DOI: 10.1080/00016340902934670ISI: 000267201800017PubMedID: 19412804OAI: oai:DiVA.org:uu-95795DiVA: diva2:170137
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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