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Intraoperative Ultrasound During Primary Cesarean Section: A Prospective, Observational Study to Measure Uterine Atony
Abstract Number: T4A-5
Abstract Type: Original Research
Ultrasonography is a widely used modality in both the obstetric and gynecologic fields for fetal, placental, and endometrial evaluation1,3. 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 bleeding2,3,4. Kohlenberg et al described its use during hysteroscopic resection of uterine septae, where ultrasonography was used to guide the depth of their resection by measurement of the uterine myometrial thickness5.
Uterine atony, or the lack of uterine contractility, is the leading cause of morbidity and mortality worldwide due to postpartum maternal hemorrhage6. Assessment of uterine atony is guided by a subjective “uterine tone”, palpated either transabdominally or directly, which directs interventions to limit hemorrhage. Currently there are no studies that validate the accuracy of this assessment of uterine tone with objective data.
In this prospective observational study, we evaluate subjective tone defined by the obstetrician and compare it to sonographic evaluation of the posterior uterine body at three time points. Patients with prior uterine scars or increased risk for uterine atony were excluded to ensure consistent evaluation of tone. The obstetrician’s assessment of uterine tone (1 “excellent” to 10 “poor”) correlated with the observed reduction in uterine thickness as seen on ultrasound, with mean atony score of 2.8 at T1 (SD +/- 1.23), decreasing to a mean of 2.0 at T2 (SD +/- 0.81), and mean of 1.6 at T3 (SD +/- 0.97). The difference between T1 and T3 was statistically significant with a p-value of 0.0433.
Based on initial results, the obstetrician can reliably assess for small improvements in uterine contractility during primary cesarean section, in an otherwise healthy parturient without risk factors for uterine atony. Additional recruitment is being completed to validate the objective measurements. If proven to be a reliable method of determining uterine contractility in the normal (control) population, we plan to proceed with phase two of the study in patients with risk factors for poor uterine contractility.
1. Coccia M.E., Arch Gynecol Obstet, 2014; 290: 843.
2. Ganesh A., EJOG, 2004; 114:1, 69-74.
3. Karlsson B., AJOG, 1995; 172:5, 1488-1494.
4. Reuter KL., AJR, 1997; 169: 541-546.
5. Kohlenberg C. F., ANZJOG, 1996; 36: 482–484.
6. Bateman, A&A. 2010; 110:5, 1368-73.