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Ultrasonographic Assessment of Uterine Contractility During Primary Cesarean Section
Abstract Number: SUN-67
Abstract Type: Case Report/Case Series
Ultrasonography is a widely used modality in both the obstetric and gynecologic fields for fetal, placental, tubo-ovarian, and endometrial evaluation(1,3). Intraoperative transabdominal ultrasound is used routinely during gynecologic procedures such as dilation and evacuation or curettage for elective termination, retained products of conception, and for postmenopausal bleeding(2,3,4). Kohlenberg et al described its use in a case study during hysteroscopic resection of uterine septae for infertility, where ultrasonography was used to guide the depth of their resection by measurement of the uterine myometrial thickness(5).
Uterine atony, or the lack of uterine contractility, is the leading cause of morbidity and mortality worldwide due to postpartum maternal hemorrhage(6). Assessment of uterine atony is guided by a subjective “uterine tone” by the obstetrician, by either transabdominal or direct palpation of the uterus. This subjective evaluation directs the use of uterotonics to limit the extent of hemorrhage(7). Currently there is no objective method to assess uterine tone or guide the effectiveness of uterotonics.
In this case series, we demonstrate decreased thickness of the posterior uterine body during subjectively adequate tone. In the images presented, measurement of distance from the internal cavity of the uterus to the external border of the posterior wall was used to show change as tone improves over time. It is evident, when analyzing the change in thickness from T1 to T3, that the distance shortens and the tissue density increases. As the uterine smooth muscle contracts after delivery, the wall of the organ narrows.
We have applied for IRB approval to perform a prospective evaluation of this technique. If our hypothesis is proven, the use of intraoperative ultrasonography could be used to eliminate inter-individual variation and establish a standard of care in assessing and evaluating the treatment of uterine atony.
1. Coccia M.E., Arch Gynecol Obstet (2014) 290: 843.
2. Ganesh A., Euro Journal of Obstet & Gyn and Repro Biology, 114:1, 2004, 69-74
3. Karlsson B., American Journal of Obstet and Gyn, 172:5, 1995, 1488-1494
4. Reuter KL., American Journal of Roentgenology. 1997;169: 541-546.
5. Kohlenberg C. F., Australian and New Zealand Journal of Obstetrics and Gynaecology, 36: 482–484.
6. Bateman, Anesthesia & Analgesia. Volume 110(5), May 2010, p 1368-73.
7. King, Anesthesia & Analgesia. Volume 111(6), Dec 2010, P 1460-66.