Uterine blood flow velocity waveforms during early postpartum course following caesarean section

Ovarian and uterine haemodynamics and their relation to steroid hormonal levels in postpartum Egyptian buffaloes

The current study aimed to assess the ovarian and uterine haemodynamics in postpartum (pp) Egyptian buffaloes and their relation to steroid hormonal levels (progesterone and estrogen). Six multiparous buffalos with normal calving were examined by using trans-rectal Doppler sonography to assess the blood flow in ipsilateral and contralateral ovarian and uterine arteries. Doppler parameters viz. peak systolic velocity (PSV), blood flow volume (BFV), resistance (RI) and pulsatility index (PI) were measured at 1st till 6th postpartum weeks. In addition, diameters (mm) of the ovarian and uterine arteries and the vascularisation area (mm2) of ovary were determined. The blood samples were collected starting from 1st week post calving and every week thereafter following each ultrasound Doppler examination for assay of progesterone and estradiol. Results indicated that PI and RI increased consistently and significantly (P<0.05) till the 6th week post calving as compared to those recorded at 1st week in ipsilateral ovarian and uterine arteries. However, the blood flow volume and peak systolic velocity in both ovarian and uterine arteries decreased gradually from 1st week till the 6th week after calving. There were very strong positive correlations between PSV and BFV, in both ipsilateral and contralateral ovarian and uterine arteries. Blood concentrations of progesterone were lower (P<0.05) during the first four weeks than those recorded at 5th and 6th postpartum weeks. This trend was reversed for blood estradiol 17-β. The results of the present investigation concluded that Doppler ultrasonography is a suitable tool for assessing changes in ovarian and uterine perfusion during the puerperium.

Effect of previous cesarean sections on second-trimester uterine artery Doppler

AIM

In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices.

METHODS

This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices.

RESULTS

The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher.

CONCLUSION

The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

Hemodynamic changes evaluated by Doppler ultrasonographic technology in the ovaries and uterus of dairy cattle after the puerperium

The present detailed study aimed to establish for the first time the ovarian and uterine hemodynamic change in dairy cows after the end of the puerperal period to investigate a possible association between Doppler indices and volume of blood flow. Twenty cows weighing 500-600 kg (mean 400 ± 50 kg) and 4-5 years of age (mean 3.2 ± 0.5 years) categorized into two main groups (true anestrum, with corpus luteum, n = 10) and (normal cyclic, n = 10), The period of examination started from day 39 till day 70 after calving with day after day routinely examination by b-mode and Doppler performed on both ovaries with ovarian arteries (OA) and uterus with uterine arteries (MUA) in the ipsilateral (ipsi) and contralateral (contra) side to ovulation, in addition to a thickness in horns and body was measured. Estradiol and progesterone were also measured. Results showed that both Doppler indices in the OA and MUA ipsi and contra had a positive (P ≤ 0.001) correlation with contra Doppler indices, but revealed a negative (P ≤ 0.05) correlation with ipsi and contra Doppler velocities, blood flow rate and volume in anestrum cows. Both ovarian and uterine ipsi indices showed an increase (P ≤ 0.05) in the anestrum cows, and both PSV and EDV of both arteries ipsilateral showed (P ≤ 0.05) a decrease in the anestrum cows, the ipsi and contra ovarian and uterine colored % were lower in anestrum group than the normal group. Estradiol (P ≤ 0.05) decreased in anestrum cows than the normal, while progesterone increased in the anestrum group. Conclusion, although uterine and ovarian morphology were changed in anestrum cows, the vascular system of the ovary as well as uterus underwent much more marked vascular changes, the most significant being that of blood flow velocities and volume.

Uterine artery pulsatility index in hypertensive pregnancies: When does the index normalize in the puerperium?

Objective

To investigate whether the uterine artery pulsatility index (UtA PI) of hypertensive pregnancies is higher than that of normal pregnancies in the puerperium, as well as in the antepartum period.

Methods

The UtA PI was measured in hypertensive (group 1) and normal pregnancies (group 2) during antepartum, immediate postpartum or late postpartum periods. Using the transvaginal approach, the bilateral uterine artery indices were measured.

Results

One hundred twenty-two women were enrolled: group 1, hypertensive disease in pregnancy (11 cases in antepartum, 13 cases in immediate postpartum and 10 cases in late postpartum period); group 2, normal pregnancies (32 cases in antepartum, 29 cases in immediate postpartum and 27 cases in late postpartum). In antepartum and immediate postpartum periods, the mean UtA PI and the proportion of cases with an early diastolic notch were higher in group 1 than in group 2 (antepartum mean UtA PI, 1.14 in group 1 vs. 0.68 in group 2, P<0.001; early diastolic notch, 46% vs. 9%, P<0.05; immediate postpartum mean UtA PI, 1.30 vs. 1.08, P<0.05; early diastolic notch, 85% vs. 48%, P<0.05). In late postpartum period, the mean value of UtA PI of group 1 was still higher than that of group 2, although the proportion of cases with an early diastolic notch was not different (mean UtA PI, 1.43 vs. 1.20, P<0.05; early diastolic notch, 60% vs. 52%, P=0.73).

Conclusion

The UtA PI in hypertensive pregnancies was still higher than normal pregnancies in puerperal periods, suggesting that more than several weeks are required to resolve increased uterine artery vascular impedance.

Postpartum uterine artery blood flow impedance following cesarean section or vaginal delivery

PURPOSE

To compare uterine arteries (UtA) blood flow after cesarean section (CS) or vaginal delivery (VD).

METHODS

We performed a prospective case-control study comparing UtA blood flow impedance in patients who delivered by CS or VD. The UtA pulsatility index (PI) was measured with Doppler ultrasound during post partum using a transabdominal convex probe. Maternal and gestational age, parity, gravidity, and delay between delivery and Doppler measurement were noted.

RESULTS

We examined 106 postnatal patients, of whom 35 had CS delivery and 71 had VD. The median delay from delivery to Doppler measurement was 35 hours for the CS group and 32 hours for the VD group. The mean PI following CS and VD was 1.62 ± 0.45 and 1.42 ± 0.47, respectively. Using a linear model, the regression coefficients for mean, right, and left PI were not significantly different depending on the mode of delivery. There was no difference between emergency and elective CS.

CONCLUSIONS

Early postpartum UtA blood flow impedance is not significantly different after CS or VD. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:278-283, 2016.

Randomized Controlled Trial on the Effect of Channa striatus Extract on Measurement of the Uterus, Pulsatility Index, Resistive Index of Uterine Artery and Superficial Skin Wound Artery in Post Lower Segment Caesarean Section Women

AIM

To compare the mean of anteroposterior (AP) measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo.

BACKGROUND

Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain.

METHODOLOGY

This study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS). Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3) and at two weeks, four weeks and six weeks post-operatively.

RESULTS

Sixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI) and the resistive index (RI) of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively).

CONCLUSION

Daily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS.

TRIAL REGISTRATION

www.isrctn.com 11960786.

Uterine artery impedance during the first eight postpartum weeks

The aim of this study was to construct reference ranges for the uterine artery (UtA) mean pulsatility (PI) and resistance (RI) indices from 1–8 weeks postpartum. A prospective, cross-sectional, and observational study was performed with 320 healthy women from week 1 through week 8 postpartum. UtAs were examined transvaginally using colour and pulsed Doppler imaging, and the means of the right and left values of the PI and RI, as well as the presence or absence of a bilateral protodiastolic notch, were recorded. The 5^th, 50^th and 95^th reference percentile curves for the UtA-PI and UtA-RI were derived using regression models. The adjusted reference intervals uncovered a convergence trend at the week 8 time-point, although impedance was lower at the week 1 time-point in multiparous women compared with primiparous women. The notching prevalence was 22.5% (9/40) at week 1 and 95.0% (38/40) at week 8. The study revealed consistent evidence of a progressive increase of postpartum uterine impedance and provided new average UtA-PI and UtA-RI reference charts for weeks 1 through 8. Multiparity does not change the trend but does impart a lower rate of increase, likely as a consequence of previous vascular structural and functional differences.

Transrectal Doppler sonography of uterine blood flow during the first two weeks after parturition in Simmenthal heifers

Transrectal Doppler sonography was used to evaluate uterine blood flow during the first two weeks after parturition in six primiparous Simmental cows. The uterine blood flow was evaluated on the day of parturition (Day 0), once daily from Days 1 to 8 and then every other day until Day 14. Blood flow was quantified by determining the diameter (D), the time-averaged maximum velocity (TAMV), the pulsatility index (PI) and the blood flow volume (BFV) of the uterine arteries ipsilateral and contralateral to the formerly pregnant uterine horn. During the first four days after calving D, TAMV and BFV declined (ipsilateral: TAMV 70%, BFV 87%, contralateral: D 47%, BFV 84%; p < 0.05), while PI increased (ipsilateral 158%, contralateral 100%; p < 0.05) distinctly. Between Days 4 and 14 only the ipsilateral D (12%) and the BFV of both arteries (ipsilateral 5%, contralateral 8%) decreased (p < 0.05). Blood flow variables were very strongly correlated with each other (r > ±0.75, p < 0.05), with negative correlations with PI and positive correlations with all other investigated factors. Overall, this study revealed characteristic changes in uterine perfusion during the first two weeks after parturition in cows that were pronounced during the first four days postpartum.