OB-GYN-L Messages for January, 2004: Re: Priority in Post partum retained products?

Re: Priority in Post partum retained products?

From: art fougner, md

evsono@pipeline.com

Sun Jan 11 09:58:12 2004

Ultrasound Obstet Gynecol. 2001 Nov;18(5):491-8.

Ultrasonic evaluation of the uterus and uterine cavity after normal, vaginal delivery.

Mulic-Lutvica A, Bekuretsion M, Bakos O, Axelsson O.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. ajlana.mulic-lutvica@kk.uas.lul.se

OBJECTIVE: To describe uterine and uterine cavity changes throughout the puerperium, as revealed by ultrasound. METHODS: This was a prospective, longitudinal study in which 42 women with uncomplicated vaginal term deliveries were examined serially by ultrasound on postpartum days 1, 3, 7, 14, 28 and 56. The first four examinations were performed transabdominally and the last two transvaginally. 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, breast-feeding, maternal smoking and infant's birth weight were also evaluated. RESULTS: The maximum anteroposterior diameter of the uterus diminished substantially and progressively from 92.0 mm on day 1 postpartum to 38.9 mm on day 56. The maximum anteroposterior diameter of the uterine cavity diminished from 15.8 mm on day 1 to 4.0 mm on day 56. However, the anteroposterior diameter of the uterine cavity, 5 cm from the fundus, typically increased on days 7 and 14 postpartum. The position of the uterus and the shape and the appearance of the cavity change in a unique way during the normal puerperium. The uterus was most often retroverted and empty in the early puerperium. Fluid and debris in the whole cavity were seen in the middle part of the puerperium. In late puerperium the cavity was empty and appeared as a thin white line. Endometrial gas was occasionally visualized. No correlation was found between the involution of the uterus and parity, breast-feeding and the infant's birth weight. CONCLUSION: Transabdominal sonography is suitable for examination of the uterus during the first 14 days postpartum but from day 28 the transvaginal route is preferable. The uterine body and position, as well as the cavity, are easy to examine by ultrasound. Accumulation of fluid and debris in the uterine cavity is a common and insignificant finding of the involuting uterus. It is located in the cervical area in the early puerperium and in the whole uterine cavity in the middle part of the puerperium. Findings from uncomplicated vaginal deliveries are needed as a reference when the diagnostic efficacy of ultrasound for pathological conditions is to be tested.

art

At Sat, 10 Jan 2004, RModugno@aol.com wrote: >
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>In a message dated 1/8/2004 4:52:18 PM Eastern Standard Time,
>jmsmed58@hotmail.com writes:
>FURTHER CASE DETAILS
>
>This patient below went to get an ultrasound yesterday. This is in
>Australia everyone. The ultrasonographer could definitely see that
>there was still fluid and debris in the uterus. How much she didnt say.
>The results from the ultrasound will be delivered to the Dr tomorrow.
>
>The vaginal bleeding has slowed down and is starting
>to look like its clearing up.
>
>So, if anyone else has any input I would appreciate it. Now that a few
>of you have checked out my qualifications, perhaps you might respond. :)
>
>Kind regards
>
>Joanne.
>Joanne, it is diificult to tell ultrasonically the difference between
>retained placental fragments and blood clots and debris I don't know of any large
>studies of ultrasound of "normal" postpartum uteri. Therefore, the best
>management is by clinical judgement. If the bleeding is slowing dow. then certainly
>expectant mangement is the best. Treatment for possible endometritis with
>antibiotics and uterine "ecbolics" such as methergine/ergometrine is not unreasonable.
>
>Robert Modugno MD MBA FACOG
>Marietta, GA
>http://www.novaobgyn.yourmd.com
>
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>In a message dated 1/8/2004 4:52:18 PM Eastern Standard Time, jmsmed58 hotmail.com writes:
>FURTHER CASE DETAILSThis patient belo went to get an ultrasound yesterday. This is inAustralia everyon . The ultrasonographer could definitely see thatthere was still f uid and debris in the uterus. How much she didnt say.The results rom the ultrasound will be delivered to the Dr tomorrow.The vaginal bleeding has slowed down and is startingto look like its clearing up.So, if anyone else has any input I would appreciate it. No that a fewof you have checked out my qualifications, perhaps you might respond. :)Kind regardsJoanne.
>Joanne, it is diificult to tell ultrasonically the difference between etained placental fragments and blood clots and debris I don't know of any large studies of ultrasound of "normal" postpartum uteri. Therefore, th best management is by clinical judgement. If the bleeding is slowing dow. hen certainly expectant mangement is the best. Treatment for possible endom tritis with antibiotics and uterine "ecbolics" such as methergine/ergometri e is not unreasonable.
>
>Robert Modugno MD MBA FACOG
>Marietta, GA
>http://www.novaobgyn.yourmd.com
>
>
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-- art fougner, md ich bin ein New Yorker

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