Sonographic Evaluation of the Puerperal Uterus: Correlation with Manual Examination

Shalev, Josef; Royburt, Moshe; Fite, G.; Mashiach, Reuven; Schoenfeld, Alex; J, Bar; Ben‐Rafael, Zion; Meizner, Israel

doi:10.1159/000049409

Cited by 23 publications

(13 citation statements)

References 4 publications

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“…There have been contradicting reports on the association between uterine size after cesarean deliveries in comparison to vaginal deliveries. In a study of 120 women, Shalev et al 13 found that the uterine length was significantly higher in women after cesarean deliveries compared to vaginal deliveries. They concluded that the uterine involution after vaginal delivery differs from that after cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Added Value of 3-Dimensional Sonography for Endometrial Evaluation in Early Puerperium

Weissmann-Brenner

Haas

Gilboa

et al. 2013

Journal of Ultrasound in Medicine

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Objectives The purpose of this study was to examine the uterine cavity within 48 hours of delivery using 2‐ and 3‐dimensional sonography after normal vaginal deliveries, instrumental deliveries, exploration of the uterine cavity, and cesarean deliveries. Methods A prospective study was performed in puerperal women with normal clinical examination findings. Measurements of the uterine length and width were taken in the midsagittal and coronal planes. Midsagittal measurements of the endometrium using 2‐ and 3‐dimensional sonography and virtual organ computer‐aided analysis were performed. Comparisons were made between normal and surgical vaginal deliveries, cesarean deliveries, and after exploration of the uterine cavity. Results A total of 123 patients were examined. Seventy‐seven patients had normal vaginal deliveries; 21 had assisted vaginal deliveries; and 25 had cesarean deliveries. Thirteen underwent exploration of the uterine cavity. The uterine volume increased significantly as the birth weight increased and after cesarean delivery (P < .05). No correlation was found between the endometrial volume and parity, birth weight, and mode of delivery, including no correlation with exploration. Five cases of placental residua were found in asymptomatic women. All delivered vaginally. None underwent exploration of the uterus. All had irregular echogenic masses in the uterine cavity with positive color Doppler findings. The endometrial thickness and volume were significantly higher in these patients. Conclusions Sonography along with Doppler assessment has added value in the clinical evaluation of the puerperal women, being able to also show residua in asymptomatic women. Three‐dimensional sonography did not show an advantage over 2‐dimensional sonography in the estimation of the puerperal uterus or residua.

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Section: Discussionmentioning

confidence: 99%

Added Value of 3-Dimensional Sonography for Endometrial Evaluation in Early Puerperium

Weissmann-Brenner

Haas

Gilboa

et al. 2013

Journal of Ultrasound in Medicine

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“…The presence of blood, blood clots, necrotic decidua, membranes or gas can give various ultrasound images and a proper diagnosis is sometimes difficult. Nevertheless, the most common ultrasound finding associated with RPT is an echogenic mass 8,[34][35]55,[57][58][59][60][61][62][63][64][65][66][67][68] (Figs 9A to C, 10A and B, 11A and B, 12A, 13A to C and 14A). In contrast, Edwards et al 15 found in his study an echogenic mass on day 7 in 51% of normal cases, in 21% on day 14 and in 6% on day 21.…”

Section: Retained Placental Tissuementioning

confidence: 99%

Postpartum Ultrasound

Mulic‐Lutvica¹

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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This article describes uterine and uterine cavity changes throughout the normal and pathological puerperium, as revealed by various ultrasound modalities. A gray scale ultrasound, color and pulsed Doppler ultrasound and 3D ultrasound were used. It is based on results of several prospective longitudinal studies, which were designed so that every woman was examined at six occasions during the puerperium, namely on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. The same design was used in all studies. The involution process of the uterus was assessed by measuring the anteroposterior diameter of the uterus and uterine cavity. Morphological findings were recorded. The influence on the involution process of parity, breastfeeding, maternal smoking and infant's birth weight were also evaluated. Besides conventional ultrasound, Doppler technology was used to study hemodynamic events occurring during the normal puerperium. The pulsatility (PI) and resistance (RI) indices in the uterine arteries were measured, and the presence or absence of early diastolic notches was recorded. A hypervascular area in myometrium was assessed by color and power Doppler. Normal involution process was also described by means of 3D ultrasound. The volume of the uterus and uterine cavity after normal vaginal delivery were measured using virtual organ computer-aided analysis (VOCAL) using six adjacent planes and a 30° rotation method. Reference values from uncomplicated puerperium were used when pathological conditions were studied.Results from these studies, which shed light on normal and pathological changes during the puerperium, are summarized in this chapter.

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“…Sa sensibilité est supérieure à l'examen clinique et à l'expression utérine. 16 Chez notre patiente, l'examen clinique ne démontrait pas de saignement. L'intérêt de l'échographie pelvienne est majeur en cas d'hémorragie survenant après une césarienne.…”

Section: Discussionunclassified

“…L'intérêt de l'échographie pelvienne est majeur en cas d'hémorragie survenant après une césarienne. 16 Les informations qu'elle apporte sont multiples. Dans une étude réalisée chez 125 patientes ayant une hémorragie de la délivrance, la présence d'une masse intra-utérine ou d'un épanchement intra-abdominal était associée à un mauvais pronostic.…”

Section: Discussionunclassified

Pré-éclampsie sévère et hémorragie post-partum: apport de l’échographie « corps entier »

Zieleskiewicz

Pierrou

Ragonnet

et al. 2013

Can J Anesth/J Can Anesth

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RésuméObjectif La prise en charge des patientes pré-éclamptiques sévères est un défi pour les équipes travaillant en secteur obstétrical. Nous montrons ici que l'échographie de plusieurs organes du corps réalisée au lit d'une patiente a apporté des informations nécessaires à la prise en charge, sans nécessité de la transférer en service de radiologie ni d'avoir recours à des intervenants extérieurs. É léments cliniques Une patiente pré-éclamptique sévère de 29 ans avec un HELLP syndrome (hémolyse, cytolyse, thrombopénie) développe en post-partum une hémorragie utérine occulte diagnostiquée grâce à une échographie abdomino-pelvienne réalisée au chevet. L'échoguidage a aussi simplifié la mise en place d'un abord veineux central. Cette patiente évolue favorablement après une hystérectomie d'hémostase et l'administration de facteur VII activé. Les échographies pulmonaire et cardiaque ont optimisé la prise en charge hémodynamique non invasive de cette patiente ayant développé un choc hémorragique puis un oedème pulmonaire. L'échocardiographie a guidé le remplissage vasculaire et l'échographie pulmonaire a permis de détecter l'apparition de l'oedème pulmonaire interstitiel et d'en suivre l'évolution. Conclusion Les praticiens doivent être informés de l'intérêt de l'échographie du « corps entier » dans le diagnostic et le traitement de pathologies complexes impliquant plusieurs organes, comme la pré-éclampsie. De plus, l'échographie facilite la prise en charge de l'hémodynamie globale. La formation des anesthésiologistes aux différentes techniques échographiques devrait être encouragée. AbstractPurpose Management of severe pre-eclamptic patients is a challenge for the staff on obstetrical wards. We demonstrate that ultrasound applied to several organs performed at a patient's bedside gave the information required for the patient's management, without the need to transfer her to the radiology department or to call external consultants. Clinical features A 29-yr-old severely pre-eclamptic patient with HELLP syndrome (hemolysis, cytolysis, thrombopenia) presented, in the post-partum period, with an occult uterine hemorrhage diagnosed with bedside abdominal/pelvic ultrasound. Ultrasound was also used to insert a central venous catheter. After undergoing a

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Sonographic Evaluation of the Puerperal Uterus: Correlation with Manual Examination

Cited by 23 publications

References 4 publications

Added Value of 3-Dimensional Sonography for Endometrial Evaluation in Early Puerperium

Added Value of 3-Dimensional Sonography for Endometrial Evaluation in Early Puerperium

Postpartum Ultrasound

Pré-éclampsie sévère et hémorragie post-partum: apport de l’échographie « corps entier »

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