Cesarean Delivery Changes the Natural Position of the Uterus on Transvaginal Ultrasonography

Agten, Andrea Kaelin; Honart, Anne West; Monteagudo, Ana; McClelland, Spencer; Basher, Basmy; Timor‐Tritsch, I. E.

doi:10.1002/jum.14461

Cited by 18 publications

(16 citation statements)

References 20 publications

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“…The uterus is anteflexed in about 50% of women in a normal population [ 19 ], but tends to change position into more pronounced anteflexion post-cesarean. While some authors conclude that a CS changes the uterus into a retroflexed position [ 20 ], most sonographic studies of post-cesarean uteri show an overall increase of anteflexion up to a prevalence of 80% [ 21 ]. This cohort shows similar findings with predominantly anteflexed uteri post-cesarean which could indicate that CS increases uterine anteflexion.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of the sonographic post-cesarean uterus

Naimi

Wolnicki

Mouzakiti

et al. 2021

Arch Gynecol Obstet

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Purpose We aim to describe the sonographic uterine anatomy after a cesarean section (CS), test the reproducibility of predefined measurements from the BSUM study, and report the distribution of these measurements. Methods This is a descriptive observational study where 200 women with a history of only one CS were recruited 12–24 months postoperatively. A 5–13 MHz micro-convex transvaginal transducer was used for the acquisition of volumetric datasets for evaluating the CS scars. We defined 15 distinct measurements including the residual myometrial thickness (RMT). RMT ratio was calculated as a percentage of RMT to the assumed pre-cesarean anterior uterine wall thickness. A P value below 0.05 is utilized for significant statistical analysis. Results Patients were included on average 18.5 months post-cesarean. The uterus was anteflexed in 82.5% and retroflexed in 17.5%. Myometrial defects at the site of CS manifest in two forms, either as a niche or as fibrosis. Patients are classified into four groups: those with isolated niches (45%), combined niches and fibrosis (38.5%), isolated fibrosis (11%), and lacking both (5%). The median RMT ratio for these groups was 63.09, 40.93, 59.84, and 100% with a standard deviation of 16.73, 12.95, 16.59, and 0, respectively. The interclass correlation coefficient (ICC) remained above 0.9 for all distinct measurements among these groups except for those of RMT, where ICC varied between 0.47 and 0.96. The RMT ratio shows a constant ICC at 0.94 regardless of the group. Conclusion The post-cesarean uterus is often anteflexed, and a myometrial loss of about 50% is normally expected. The pattern of this loss is in the form of a predominantly sharp-edged and echogenic niche, fibrosis, or a combination of both. The proposed RMT ratio takes these changes into consideration and results in a reproducible quantification. We hypothesize that different adverse outcomes could be attributed to the different scar patterns.

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Section: Discussionmentioning

confidence: 99%

Anatomy of the sonographic post-cesarean uterus

Naimi

Wolnicki

Mouzakiti

et al. 2021

Arch Gynecol Obstet

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“…Interestingly, non‐gravid patients demonstrate a significantly greater incidence of uterine retroflexion in women with a history of Cesarean delivery, as reported by three separate groups 11–13 . In a retrospective review of 641 transvaginal ultrasound images, Sanders and Parsons reported uterine retroflexion in 27% of patients who had undergone Cesarean delivery, as opposed to 1% in multiparous patients without a history of Cesarean delivery and none in nulliparous patients 11 .…”

Section: Discussionmentioning

confidence: 88%

FundAl Retroflexion (FAR) Angle is a Novel Sonographic Marker Associated With Cesarean Scar Pregnancies in the First Trimester

Zhang-Rutledge

Pinson

Perez

et al. 2021

J of Ultrasound Medicine

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Objectives Early diagnosis of Cesarean scar pregnancies (CSP) remains difficult. This study describes a novel sonographic marker, the FundAl Retroflexion (FAR) angle, that may be used in the first trimester. The objective of the study is to compare the FAR angle between CSP and normal pregnancies. Methods For this case–control study, we reviewed images from our institution's database that were acquired from January 2016 to December 2019. All cases of CSP and randomly selected controls, defined as patients with history of Cesarean delivery and normal implantation, that underwent ultrasound evaluation at <14 weeks were included. The FAR angle, defined as the acute angle created between the endometrial echo and cervical canal, was measured. The mean FAR angle was then compared between the two groups and a receiver operating characteristic (ROC) curve was generated. Results We identified 15 cases of CSP during the study period and were able to measure the FAR angle in 14 of the cases. The mean FAR angle was larger in CSP than in normal control pregnancies (45° versus 27°, respectively, P < 0.001). Using an ROC curve, a FAR angle cut off of 40° maximizes the ability to distinguish between CSP from normal pregnancies. Conclusions The FAR angle provides an easily obtainable and numerical measurement. CSP have larger FAR angle compared to normal controls with a distinguishing cut off of 40°. Larger studies are needed to determine if using the FAR angle can improve first trimester diagnosis for CSP.

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“…During pregnancy, the uterus of the mother will undergo a series of changes as the fetus develops, including the increase in uterine volume and weight, the increase in blood flow in various parts of the uterus, and changes in nerve distribution, tissue hormone level, and their receptors. When the fetus is full term, the uterus will undergo a series of changes as delivery occurs to ensure that all changes that occurred during pregnancy will recover or be restored to pre-pregnancy status to fully prepare for the next pregnancy (Kaelin Agten et al, 2018). The uterus and ovaries are dependent on and interact with each other in morphology and regulation of endocrine secretion during recovery of reproductive function in female animals.…”

Section: Discussionmentioning

confidence: 99%

“…At the uterus, the internal iliac artery supplies the uterus and is anastomosed with the ovarian arteries (branch of the aorta) and is connected to the inferior and superior vaginal blood vessels. At the same time, the lymph nodes of the uterine body are 168 H. Yang et al: Comparative analysis of differentially expressed miRNAs in ovary and uterus extended to the pelvic cavity on one side and the para-aortic lymph nodes on the other side (Ercoli et al, 2010;Lanciego et al, 2012;Abe et al, 2014;Hamadeh et al, 2018). At the endocrine secretion level, the ovaries synthesize and secrete steroid hormones such as E 2 and P 4 .…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of differentially expressed miRNAs related to uterine involution in the ovine ovary and uterus

Yang

Luo

et al. 2021

Arch. Anim. Breed.

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Abstract. To examine the possible miRNA molecular regulatory mechanisms during maternal uterine involution after delivery, we selected ovary and uterus tissues that are structurally connected as experimental materials. We employed Illumina HiSeq sequencing to screen and analyze the quantity and characteristics of miRNA in postpartum ewes in the methylergometrine-treated group and physiological saline control group. Results showed that 16 miRNAs were identified in the ovary libraries, including 4 known miRNAs and 12 novel miRNAs. In the uterus libraries, 54 miRNAs were identified, which included 5 known miRNAs and 49 novel miRNAs. At the same time, target gene prediction, GO annotation, and KEGG signaling pathway enrichment analysis were employed. We found that maternal uterine involution after delivery may involve two miRNA-target gene pairs, i.e., miRNA-200a-ZEB1 and YAP1. The YAP1/Hippo signaling pathway is used to construct an ovary–uterine axial regulatory mechanism to regulate the restoration of postpartum maternal uterine morphology and function. In view of this, the identification of miRNAs with significant differences in this study fills a gap in research on miRNAs associated with regulation of postpartum uterine recovery in ewes and provided an important reference for comprehensive understanding and in-depth research on the regulatory molecular network mechanism for postpartum uterine involution in small ruminants.

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Cesarean Delivery Changes the Natural Position of the Uterus on Transvaginal Ultrasonography

Cited by 18 publications

References 20 publications

Anatomy of the sonographic post-cesarean uterus

Anatomy of the sonographic post-cesarean uterus

FundAl Retroflexion (FAR) Angle is a Novel Sonographic Marker Associated With Cesarean Scar Pregnancies in the First Trimester

Comparative analysis of differentially expressed miRNAs related to uterine involution in the ovine ovary and uterus

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