Involution of the postpartum uterus: An ultrasonic study

VanRees, Douglas; Bernstine, Richard L.; Crawford, William L.

doi:10.1002/jcu.1870090203

Cited by 17 publications

(9 citation statements)

References 4 publications

(1 reference statement)

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“…The average time of this involution given in the obstetrical literature is approximately 3 months [8]. Willms et al described the normal involution of the postpartum pelvis from less than 30 h to 6 months after normal vaginal delivery [9].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging evaluation of incision healing after cesarean sections

et al. 1997

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The purpose of this study was to examine the healing period of incision scar in myometrial wall and the normal pelvis after cesarean sections by means of MRI. In this study 17 voluntary women were examined after their first delivery with cesarean section in the early postpartum period (first 5 days), and following this, three more times in 3-month intervals. The MRI examinations were performed on a 1.0-T system (Magnetom, Siemens, Erlangen, Germany), and sagittal T1-weighted (550/17 TR/TE) and T2-weighted (2000/80 TR/TE) spin-echo (SE) images of the pelvis were obtained. During follow-up examinations incision scar tissues lost their signals within the first 3 months on both SE sequences, and little alteration was observed in the subsequent tests. Zonal anatomy of the uterus reappeared completely 6 months after cesarean sections. The time for the involution of the uterus was independent of the zonal anatomy recovery, and the maximum involution was inspected within the first 3 months. In conclusion, the maturation time of myometrial scar tissue in uncomplicated cesarean sections, which can be evaluated by the signal alterations in MRI, is approximately 3 months, whereas the complete involution and the recovery of the zonal anatomy need at least 6 months.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging evaluation of incision healing after cesarean sections

et al. 1997

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“…7 We found no difference between nursing and nonnursing mothers with respect to uterine involution, confirming the findings of two smaller previous studies. 2 • J Although we also studied a relatively small number of nursing women, such women returned substantially more often than the others for follow-up scans, composing 19% of women scanned in the mid-postpartum period and 28% of those scanned in the late postpartum period. Consequently, any substantial effect of breast feeding on uterine involution should have been evident.…”

Section: Discussionmentioning

confidence: 99%

“…l -3 Moreover, uterine dimensions were markedly discrepant between studies, particularly the mean sagittal dimension, which varied from 17.3 to 21.2 cm in the early postpartum period.t. 2 In two studies the sagittal dimension was measured from the fundus to the internal cervical OS,2.3 apparently excluding the cervix, which was incorporated into the sagittal measurement in the other study. 1 Citing unspecified effects of bladder distention on uterine measurements, previous investigators scanned subjects at varying degrees of bladder fullness ranging from emptyJ to moderately distended' to full.…”

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confidence: 99%

“…1 Citing unspecified effects of bladder distention on uterine measurements, previous investigators scanned subjects at varying degrees of bladder fullness ranging from emptyJ to moderately distended' to full. 2 Measurements in these se-ries were obtained up to but not after 3 weeks post partum, when uterine involution is as yet incomplete. The number of study participants was relatively small (s AO) in all three series.…”

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confidence: 99%

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Real-time ultrasonographic analysis of the normal postpartum uterus: technique, variability, and measurements.

Wachsberg

Kurtz

Levine

et al. 1994

Journal of Ultrasound in Medicine

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We evaluated normal uterine involution prospectively with real-time ultrasonography in 100 women after uncomplicated term vaginal delivery. Transducers easily distorted the spongy uterus during early postpartum scanning, an effect minimized with sector transducers that are superior to linear or convex probes for accurate early postpartum uterine measurement. Long-axis measurements correcting for uterine angulation were the most reproducible and accurate, irrespective of bladder distention. Uterine T o our knowledge, only three studies have addressed ultrasonographic measurement of normal postpartum uterine dimensions. 1-J Since only static scanners were utilized in these studies, the reported dimensions bear uncertain relevance to real~time ultrasonography owing to two factors: (1) The long axis of the postpartum uterus often is oriented obliquely rather than parallel to the sagittal plane of the body." Imaging in standard orthogonal planes may therefore underestimate the true sagittal uterine dimension. (2) Our initial real-time ultrasono--graphic observations indicated that the early postpar- contractions caused instability of particularly the transverse dimension. Increasing maternal parity was associated with slightly but significantly larger uterine dimensions up to 4 weeks post partum. The uterus reassumed nongravid dimensions by 6 to 8 postpartum weeks. Uterine involution was unrelated to infant birth weight or breast feeding. KEY WORDS: Uterus, ultrasonography; Uterus, size; Puerperium; Uterine involution; Obstetrics, ultrasonography; Pregnancy, ultrasonography. tum uterus is highly susceptible to distortion from trivial pressure applied via hand-held transducers as opposed to articulated-arm probes that glide across the abdominal skin surface without producing distortion.In each of the cited studies the sagittal dimension apparently was measured without correction for an~ gulation of the uterus as it arches over the sacral promontory in the early postpartum period. l -3 Moreover, uterine dimensions were markedly discrepant between studies, particularly the mean sagittal dimension, which varied from 17.3 to 21.2 cm in the early postpartum period.t. 2 In two studies the sagittal dimension was measured from the fundus to the internal cervical OS,2.3 apparently excluding the cervix, which was incorporated into the sagittal measurement in the other study. 1 Citing unspecified effects of bladder distention on uterine measurements, previous investigators scanned subjects at varying degrees of bladder fullness ranging from emptyJ to moderately distended' to full.

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“…[3][4][5][6][7] However, few studies have focused on USG investigations during the puerperium and results of published studies are not unambiguous. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] In published studies concerning the involution process, the length, 4,[6][7][8][9]11,12,14 width, 8,9,12 anteroposterior diameter, [3][4][5][6][7][11][12][13]16 area, 9 thickness of the uterine wall 10 and volume of the uterus and the uterine cavity, 15 have been used as a measure of uterine involution. Majority of the studies described pathological conditions without knowledge about normal findings, 4,5,8 they were restricted to the early puerperium and designs were crosssectional.…”

Section: Introductionmentioning

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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Involution of the postpartum uterus: An ultrasonic study

Cited by 17 publications

References 4 publications

Magnetic resonance imaging evaluation of incision healing after cesarean sections

Magnetic resonance imaging evaluation of incision healing after cesarean sections

Real-time ultrasonographic analysis of the normal postpartum uterus: technique, variability, and measurements.

Postpartum Ultrasound

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