Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications.

Abstract

OBJECTIVE:

To investigate dynamic changes in myometrial thickness during the third stage of labor.

METHODS:

Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated.

RESULTS:

There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed.

CONCLUSION:

A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage.

• Authors: Manasi Patwardhan, Edgar Hernandez-Andrade, Hyunyoung Ahn, Steven J Korzeniewski, Alyse Schwartz, Sonia S Hassan, Roberto Romero
• Journal: Gynecologic and obstetric investigation (Gynecol Obstet Invest) Vol. 80 Issue 1 Pg. 26-37 ( 2015) ISSN: 1423-002X [Electronic] Switzerland
• PMID: 25634647 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural)
• Copyright: © 2015 S. Karger AG, Basel.

Topics

• Adult
• Female
• Humans
• Labor Stage, Third (physiology)
• Myometrium (diagnostic imaging, physiopathology)
• Obstetric Labor Complications (diagnostic imaging)
• Postpartum Hemorrhage (diagnostic imaging)
• Pregnancy
• Pregnancy Complications (diagnostic imaging)
• Risk Factors
• Time Factors
• Ultrasonography