Ultrasonographic Evaluation of Normal and Pathologic Puerperium

Puerperium represents a period of profound physiological and anatomical changes aimed to return to the pre-pregnancy state. As showed by the almost half maternal deaths reported related to this period, the correct diagnosis and treatment of any complication is of paramount importance. In this scenario, the ultrasonographic evaluation has a key role as first level tool to identify and diagnose any complication and to address the cause of any pathological sign and symptom. Ultrasound evaluation is able to identify or exclude retained products of conception or arteriovenous malformations in case of postpartum hemorrhage. Moreover, ultrasound allows to identify and monitor post-surgical complications after cesarean section, such as postpartum hematomas and/or pelvic abscess. Although the key role of this diagnostic tool, the reported reliability and validity of ultrasounds in the assessment of the different complications is heterogenous, and the limited specificity and sensitivity of different ultrasound appearances need to be taking into account. To address this issue, the knowledge of normal ultrasonographic appearance of genital tract during the physiological puerperal involution is the first step to achieve an accurate distinction between normal and abnormal development of puerperium

The effect of puerperal uterine disease on uterine involution in cows assessed by Doppler sonography of the uterine arteries

The objective of this study was to investigate the effects of puerperal uterine disease on uterine blood flow using trans-rectal Doppler sonography. Lactating Holstein Friesian cows (n = 44) were divided into two groups based on whether they were healthy (UD−; n = 23) or had uterine disease (UD+; n = 21) defined as retained fetal membranes and/or metritis. General clinical examination, vaginoscopy, trans-rectal palpation, and trans-rectal B-Mode sonography were conducted on Days 8, 11, 18, 25 and then every 10 days until Day 65 after calving. Doppler sonography of the uterine arteries was conducted on Day 8, during diestrus after the second ovulation (Days 40–60 after calving) and during diestrus before breeding (Days 63–75 after calving). Cows with uterine disease had greater (P < 0.05) uterine size as assessed trans-rectally compared with cows of the UD group. Sonographic measurements on Day 11 after parturition revealed a greater (P < 0.05) horn diameter in cows of the UD+ than in the UD− group. Both uterine size and uterine horn diameter decreased more earlier following parturition (P < 0.05) in cows of the UD− group. Blood flow volume (BFV) was greater and pulsatility index was less on Day 8 after calving in cows of UD+ than UD− group (P < 0.05). In cows of the UD−, but not in those of the UD+ group, there was a further reduction in BFV subsequent to Day 45 after calving (P < 0.05). The results of this study show that uterine blood flow measures by trans-rectal Doppler sonography are affected by puerperal uterine disease

Uterine artery impedance during puerperium in normotensive and chronic hypertensive pregnant women

Purpose: The present study compared the Doppler flow pulsatility indices (PI) in the uterine arteries (UtA) during the puerperium between healthy women and those with stage-1 essential hypertension who had uncomplicated pregnancies and delivered by elective caesarean section. The change in the mean arterial pressure (MAP) and body mass index (BMI) over time was also assessed. Methods: A longitudinal and prospective study was performed in singleton pregnancies of 28 normotensive (NT) and 24 hypertensive (HT) women. The UtA-PI was measured immediately before caesarean section (time 0) and at 1 week (time 1) and 4 weeks (time 2) postpartum. The presence or absence of early diastolic notches was recorded. The change in the MAP, BMI, and UtA-PI over time and between the two populations was modelled through multivariate linear regression using the generalised least squares. Results: In both groups, the UtA-PI significantly increased from time 0 to time 1 (p\0.05) and time 2 (p\0.05). Stage-1 hypertension did not change the trend but did increase the UtA-PI magnitude (p\0.05). The presence of uterine artery notching increased over time, from 6 to 98 %, in both groups (p\0.001); however, in the HT group, at time 1, the majority of women exhibited positive notching [92 % (HT) vs 57 % (NT), p = 0.013]. Conclusions: Chronic stage-1 hypertensive women with normal pregnancy outcomes exhibited a progressively increasing postpartum UtA impedance. This trend also occurred in normotensive women, albeit at a significantly lower magnitude. </p