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…
Contents
INTRODUCTION
General Background
Physiology of Normal Puerperium
Patophysiology of the Puerperium
Ultrasound findings of the Normal Puerperium
Gray-scale Ultrasound
Doppler Ultrasound
Ultrasound findings after caesarean section
Ultrasound findings associated with postpartum complications
Retained placental tissue – Gray scale US
Retained placental tissue – Doppler US
Postpartum endometritis
Manual evacuation of the placenta
Ethical considerations
AIMS OF THE STUDIES
MATERIAL AND METHODS
Population, study settings and design
Normal Puerperium (Study I and IV)
Gray-scale Ultrasound (Study I)
Doppler Ultrasound (Study IV)
Pathological Puerperium (Study II, III and V)
Retained placental tissue – Gray-scale Ultrasound (Study II)
Endometritis, Cesarean section and Manual evacuation of the
placenta, Gray-scale Ultrasound (Study III)
Statistical analysis
RESULTS
Normal puerperium – Gray-scale Ultrasound
Study I
Pathological puerperium – Gray-scale Ultrasound
Study II
Study III
Normal puerperium – Doppler Ultrasound
Study IV
Pathological puerperium – Doppler Ultrasound
Study V
DISCUSSION
General discussion
Study I
Study II
Study III
Study IV
Study V
Methodological considerations and limitations of the study
Strengths of the study
Clinical implications
CONCLUSIONS
ACKNOWLEDGEMENTS
REFERENCES
Author: Mulic-Lutvica, Ajlana
Source: Uppsala University Library
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