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Sundararajan S, Roy S, Polanski LT. The accuracy of ultrasound scan in diagnosing retained products of conception: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:512-531.e3. [PMID: 38008149 DOI: 10.1016/j.ajog.2023.11.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE This study aimed to analyze and summarize the evidence on the accuracy of different ultrasound methods in the diagnosis of retained products of conception. DATA SOURCES We searched Ovid SP, the Cumulative Register to Nursing & Allied Health Literature, EBSCO, and grey literature including Core, Trip, Networked Digital Library of Theses and Dissertations Global ETD search, BMJ Best Practice, PubMed, GreyLit report website (http://www.greylit.org/), Cochrane Central Register of Controlled Trials, and Google scholar (https://scholar.google.com/). STUDY ELIGIBILITY CRITERIA We included prospective and retrospective cross-sectional or Cohort studies that evaluated both ultrasound findings (before management of retained products of conception) and histopathologic results of retained products of conception at all gestational ages. METHODS We used Covidence for data extraction from the studies and quality assessment. The meta-analysis was performed using RevMan 5.4 (forest plot), MetaDTA version 2.01, and Meta-DiSc 2.0 online software. RESULTS In total, 11 studies were eligible for data extraction and meta-analysis. The total number of study participants from these 11 studies were 1567. Of these, 9 studies were included to test the accuracy of an echogenic mass, 4 studies analyzed the accuracy of endometrial thickness, and 5 studies analyzed the accuracy of color Doppler flow to predict retained products of conception. We found that echogenic mass had the highest sensitivity, specificity, and diagnostic odds ratio for predicting retained products of conception. The sensitivity, specificity, and diagnostic odds ratio were 0.915 (95% confidence interval, 0.844-0.955), 0.843 (95% confidence interval, 0.615-0.947), and 57.787 (95% confidence interval, 15.171-220.112), respectively. The diagnostic threshold for endometrial thickness was set at 10 mm with a sensitivity, specificity, and diagnostic odds ratio of 0.667 (95% confidence interval, 0.072-0.981), 0.866 (95% confidence interval, 0.375-0.986), and 12.927 (95% confidence interval, 0.23-726.582). The sensitivity, specificity, and diagnostic odds ratio of color Doppler flow were 0.850 (95% confidence interval, 0.756-0.913), 0.406 (95% confidence interval, 0.198-0.655), and 3.893 (95% confidence interval, 1.005-15.081). CONCLUSION Our review concluded that an echogenic mass is the most sensitive and specific predictor of retained products of conception after any pregnancy event. The most important limitation of our review is that the design of the studies included led to significant statistical heterogeneity.
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Affiliation(s)
- Srividya Sundararajan
- Department of Obstetrics and Gynaecology, Ipswich General Hospital, East Suffolk and North Essex NHS Trust, Ipswich, United Kingdom.
| | - Subhadeep Roy
- Department of Obstetrics and Gynaecology, West Suffolk Hospital NHS Trust, Bury St Edmunds, United Kingdom
| | - Lukasz T Polanski
- Department of Obstetrics and Gynaecology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Bretton Gate, Peterborough, United Kingdom
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Turkoglu O, Friedman P. Evaluation During Postpartum Hemorrhage. Clin Obstet Gynecol 2023; 66:357-366. [PMID: 37130377 DOI: 10.1097/grf.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Postpartum hemorrhage is an obstetric emergency that is the leading and the most preventable cause of maternal death that occurs on the day of birth. The treatment of postpartum hemorrhage in a timely fashion is crucial to prevent morbidity and mortality. The accurate assessment of blood loss during delivery and the postpartum period remains a major challenge. Hence, it is imperative to have a standardized evaluation strategy for accurate assessment of blood loss, adequate classification of hemorrhage, and timely initiated interventions. The multidisciplinary evaluation strategy should be in place regardless of the delivery route.
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Affiliation(s)
- Onur Turkoglu
- Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Perry Friedman
- Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Verma A, Shrivastava N, Sharma G, Sharma A. Sonographic Detection of Surgical Site Fluid Collections and Postoperative Maternal Morbidity Following Cesarean Section. Cureus 2023; 15:e36836. [PMID: 37123762 PMCID: PMC10140667 DOI: 10.7759/cureus.36836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is one of the most common complications after cesarean and causes much burden on the mother as well as the health care system. SSIs are defined as infections of a surgical site up to 30 days after surgery. Ultrasonography of the surgical site may be a helpful tool to detect its complication. With this background, the following study was planned to evaluate the clinical significance of sonographically detected fluid collections and post-operative maternal morbidity following cesarean section (CS) and identify risk factors associated with their formation. METHODS This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial Medical College, Meerut. A total of 1000 women, who had undergone CS were included. Sonographic examination of the cesarean site was done on the 3rd or 4th postoperative day to look for any fluid collection in the parities or pelvis. All cases were followed on the 8th postoperative day and finally on the 30th postoperative day to look for any SSIs i.e. surgical wound problems like wound infection, induration, and discharge from a surgical wound, or even wound dehiscence and postoperative morbidity. Results: Out of the total cases (1000), abdominal wound fluid collection was noted in 490 (49%) women after CS. Thirty-two patients were lost to follow-up, so 458 patients were followed, of which collection was septated or loculated in 62 (13.6%) and diffused in 396 (86.5%). Out of 62 loculated and 396 diffused cases, 21 (33.87%) and 20 (5.05%) cases reported surgical site abdominal wound infection and needed resuturing, respectively and it was found to be highly significant (p<0.001). CONCLUSION Post-operative fluid collections are common after CS. But it is the pattern of the fluid collection that determines post-operative wound infection and morbidity. Thus ultrasound of the cesarean site may be an important tool to detect surgical site wound complications earlier and to decrease postoperative morbidity.
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Giouleka S, Tsakiridis I, Kalogiannidis I, Mamopoulos A, Tentas I, Athanasiadis A, Dagklis T. Postpartum Hemorrhage: A Comprehensive Review of Guidelines. Obstet Gynecol Surv 2022; 77:665-682. [DOI: 10.1097/ogx.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Luo J, Yang M, Liu Y, Han X, Yue W. Analysis on Medication Rules of Chinese Medicinal Herb Formulae in Uterine Subinvolution Treatment Based on Data Mining. Evidence-Based Complementary and Alternative Medicine 2022; 2022:1-15. [PMID: 35399626 PMCID: PMC8991393 DOI: 10.1155/2022/1752352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/24/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022]
Abstract
Introduction Uterine subinvolution, especially the subinvolution of the placental site, can be a life-threatening disease that induces secondary postpartum hemorrhage (PPH). Chinese Herbal Medicine has been widely used to improve postpartum recovery and treat uterine subinvolution for thousands of years. Yet, there are many potential laws hidden that are worth exploring. Methods Prescriptions treating uterine subinvolution were searched and collected to form datasets. Data mining methods including frequency analysis, cluster analysis, and association rule learning were performed to uncover the potent prescription laws of uterine subinvolution treatment. Results A total of 803 formulae involving 249 herbs were obtained. The top 6 most frequently used herbs were Angelicae Sinensis Radix (Danggui), Chuanxiong Rhizoma (Chuanxiong), Leonuri Herba (Yimucao), Persicae Semen (Taoren), Zingiberis Rhizoma Preparatum (Paojiang), and Radix Glycyrrhizae Preparata (Zhigancao). Most of the 249 herbs were being warm in properties, sweet in tastes, and mainly distributed to liver and spleen meridian tropisms. Deficiency-tonifying herbs accounted for the most proportion and heat-clearing herbs ranked the second, followed by blood-activating and stasis-eliminating herbs. 6 clusters were generated by hierarchical clustering, and 5 of them were of clinical significance. 78 rules with support values over 0.25, confidence values over 0.8, and lift values greater than 1 were generated by association rule learning. Conclusion The basic principles for uterine subinvolution treatment were deficiency-tonifying, heat-clearing, blood-activating, and stasis-eliminating. Herbs with warm properties, sweet tastes, and liver and spleen meridian tropisms are generally suitable. In addition, Sheng-Hua-Tang was the most frequently used formula for the treatment of uterine subinvolution, yet the dialectical prescriptions were diversified with different patterns/symptoms.
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Jauniaux E, Putri A, Vasireddy A, Johns J, Ross JA, Jurkovic D. The role of ultrasound imaging in the management of partial placental retention after third trimester livebirth. J Matern Fetal Neonatal Med 2020; 35:2063-2069. [PMID: 32552068 DOI: 10.1080/14767058.2020.1777272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To evaluate the impact of different ultrasound signs in the management and the role of ultrasound guidance in the surgical evacuation of partial placental tissue retention.Methods: This is an observational cohort study and retrospective case assessment of 82 patients with clinical symptoms of partial placental retention following a third trimester singleton livebirth between January 2013 and May 2019. The ultrasound signs were recorded using a standardized protocol and the outcome of the management strategy and the use of ultrasound guidance during any surgical procedure was evaluated.Results: Out of the 64 patients who had a vaginal birth, 25 (39.1%) had a manual removal of the placenta at delivery. Fifteen patients were confirmed as not having retained placental tissue and did not require further treatment. Four patients were referred after failed surgical management and four after failed conservative management. All surgical procedures were vacuum aspiration and forceps removal under continuous ultrasound guidance. A significantly lower gestational age at delivery (p < .05), shorter interval between delivery and ultrasound diagnosis (p < .05) and lower number of patients presenting with heavy bleeding was found in the conservative compared to the surgical management subgroups (p < .05). The incidence of feeding vessels was significantly (p < .05) higher in the surgical than in the conservative management subgroups and associated with increased myometrial vascularity. Six patients developed intra-uterine adhesions. In four of these cases, ultrasound examination showed a hyperechoic mass surrounded by normal myometrial vascularity and no feeding vessel.Conclusions: Ultrasound imaging accurately differentiated between patient with and without partial placental retention after third trimester livebirth. Ultrasound-guided vacuum aspiration is safe and efficient in these cases.
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Affiliation(s)
- Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Atikah Putri
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Archana Vasireddy
- Early Pregnancy and Gynaecology Assessment Unit, Kings College Hospital, London, UK
| | - Jemma Johns
- Early Pregnancy and Gynaecology Assessment Unit, Kings College Hospital, London, UK
| | - Jackie A Ross
- Early Pregnancy and Gynaecology Assessment Unit, Kings College Hospital, London, UK
| | - Davor Jurkovic
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Naeiji Z, Sotudeh S, Keshavarz E, Naghshvarian N, Rahmati N. Risk factors and clinical significance of abdomino-pelvic free fluid after cesarean section: a prospective study. J Matern Fetal Neonatal Med 2019; 34:287-292. [PMID: 30957592 DOI: 10.1080/14767058.2019.1605351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Post-partum hemorrhage is a major cause of maternal mortality. Ultrasonography is a safe, rapid, and noninvasive diagnostic tool which can be used to identify and measure the abdomino-pelvic free fluid in post-partum period.Objective: This study was conducted to evaluate the risk factors and clinical significance of abdomino-pelvic free fluid after cesarean section.Method: Demographic data, indication of cesarean section, duration of operation, volume of intraoperative blood loss, and instability in vital signs, blood transfusion, decreased Hb level, and decreased urine output were documented in 100 women with cesarean delivery 4 and 24 h after surgery. Abdomino-pelvic free fluid volume was estimated by ultrasound study.Result: Four hours after cesarean, minimal, moderate, and large amount of free fluid was seen in 38(38%), 45(45%), and 17(17%) patients respectively. The volume of free fluid was decreased generally as 73 (73%) of patients had minimal amount of free fluid 24 h after surgery. There was statistically significant relationship between volume of blood loss during cesarean and the volume of free fluid 4 h (and not 24 h) after surgery. There was no statistically significant relationship between duration of operation and the volume of free fluid 4 and 24 h after cesarean. There is statistically significant relationship between free fluid volume 4 h after surgery and hemodynamic instability.Conclusion: Ultrasonography detects even minimal amount of free fluid in post-cesarean patients but cannot predict their clinical course.
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Affiliation(s)
- Zahra Naeiji
- Gynecology and Obstetrics, Mahdiyeh Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sotudeh
- Gynecology and Obstetrics, Mahdiyeh Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Keshavarz
- Gynecology and Obstetrics, Mahdiyeh Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Narjes Naghshvarian
- Gynecology and Obstetrics, Mahdiyeh Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Nayereh Rahmati
- Gynecology and Obstetrics, Mahdiyeh Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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De Winter J, De Raedemaecker H, Muys J, Jacquemyn Y. The value of postpartum ultrasound for the diagnosis of retained products of conception: A systematic review. Facts Views Vis Obgyn 2017; 9:207-216. [PMID: 30250654 PMCID: PMC6143083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The goal of this review is to evaluate the value of ultrasound for detection of retained products of conception (RCOP) after delivery. METHODS A systematic search was performed using 'postpartum', 'retained placenta', 'retained products' and 'ultrasound' resulting 82 publications, after screening titles and abstracts, 30 remained. RESULTS On gray scale ultrasound, one must be focus on a thickened endometrial echo complex (EEC) with a cut off value of 10 mm and on an intracavitary mass. If these features are not visible, RPOC is rare. However, these findings are neither specific nor conclusive for RPOC and can even be seen in a normal postpartum uterus. Detection of hypervascularity in a thickened EEC or intracavitary mass with color Doppler ultrasound is very sensitive for RPOC but still not specific nor can it exclude RPOC. MRI seems best in differentiating RPOC, arteriovenous malformations and gestational trophoblastic disease. CONCLUSION There is no consensus on a standardised method for postpartum ultrasound. More research and standardization are necessary to differentiate of normal and pathological findings in the postpartum uterus.
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Affiliation(s)
- J De Winter
- Antwerp University Hospital UZA, Department of Obstetrics and Gynaecology, Wilrijkstraat 10, 2650 Edegem,Belgium
| | - H De Raedemaecker
- Antwerp University Hospital UZA, Department of Obstetrics and Gynaecology, Wilrijkstraat 10, 2650 Edegem,Belgium
| | - J Muys
- Antwerp University Hospital UZA, Department of Obstetrics and Gynaecology, Wilrijkstraat 10, 2650 Edegem,Belgium
| | - Y Jacquemyn
- Antwerp University Hospital UZA, Department of Obstetrics and Gynaecology, Wilrijkstraat 10, 2650 Edegem,Belgium
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Paliulyte V, Drasutiene GS, Ramasauskaite D, Bartkeviciene D, Zakareviciene J, Kurmanavicius J. Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study. Obstet Gynecol Int 2017; 2017:6739345. [PMID: 28555159 DOI: 10.1155/2017/6739345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/13/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine the uterine involution period after uncomplicated delivery in primiparous and multiparous women. Methods Longitudinal prospective study. Repeated parameters were measured and endometrial contents and diastolic notch were observed. Measurements of primiparous and multiparous women were carried out after labour on the 1st, 3rd, 10th, 30th, 42nd, and 60th postpartum days. The analysis was performed using SPSS version 21. Results The median uterus parameters are bigger in multiparous group in physiological puerperium, but the decreasing trend is the same. The endometrial cavity on the 10th day was significantly wider in multiparous women and mainly echo-negative view of the uterine cavity was observed. The evaluation of the uterine angle deviation changes from an extremely retroverted position to a more anteverted position. RI of the uterine artery in both groups was low immediately after labour and significantly increased one month postpartum. Notching of the uterine artery undergoes changes, but diastolic notch does not appear in all postpartum women even after two months following labour. Conclusions The puerperium period after normal vaginal delivery depends on parity. The trend of involution in primiparous and multiparous women follows a similar pattern, yet, it lasts longer in the multiparous women. Ultrasound of uterine is certainly a useful tool after labour and may be important in facilitating an early detection of postpartum uterine complications.
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Affiliation(s)
- Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan and
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan and
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan and
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Abstract
Ultrasound assessment of the postpartum uterus has a significant role to play in the evaluation of a large proportion of symptomatic puerperal women. Often the imaging modality of choice for excluding retained placental tissue, correct application of postpartum ultrasound could enable more accurate identification of women requiring surgical intervention, with consequent reduction in patient morbidity and clinical workload. This article aims to review the current understanding and application of ultrasound in the puerperium and evaluate the current evidence investigating the physiological and pathological findings of the postpartum uterus and its contents.
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Affiliation(s)
- Aslı Üçyiğit
- Early Pregnancy and Gynaecology Scanning Unit, King's College Hospital NHS Foundation Trust, UK
| | - Jemma Johns
- Early Pregnancy and Gynaecology Scanning Unit, King's College Hospital NHS Foundation Trust, UK
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Omakwu O, Uppal T, Infante Torres F. The role of ultrasonography in the management of post-partum haemorrhage associated with retained products of conception: A case report. Australas J Ultrasound Med 2016; 19:78-83. [DOI: 10.1002/ajum.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Oine Omakwu
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
| | - Talat Uppal
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
| | - Fernando Infante Torres
- Department of Obstetrics and Gynaecology; Northern Beaches Health Service; Mona Vale New South Wales Australia
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Abstract
OBJECTIVES The principal objective of our study was to describe the frequency of severe secondary postpartum hemorrhages (PPH). Our secondary objectives were to describe the different causes of PPH and to assess if the PPH etiologies varied by parity. METHODS This is a historical cohort study covering the period from January 1, 2004, through February 13, 2013, in a level III maternity ward. Women were eligible if they were treated for severe secondary PPH during their postpartum hospitalization or were admitted for it after discharge but before the 42nd day postpartum, regardless of the type of delivery. Women were excluded if they gave birth before 22 weeks of gestation or if they had experienced only an immediate PPH (≤ 24 hours after delivery). Eligible patients were identified by the hospital's administrative software. Primiparas and multiparas were compared with Student's t test and a chi-squared or Fisher's exact test. RESULTS The incidence of severe secondary PPH was 0.23 percent (n = 60/26,023). The mean time between delivery and PPH onset was 13.4 ± 10.8 days. The women's mean age was 30.4 ± 5.7 years and their mean body mass index was 23.4 ± 5.7 kg/m². Placental retention was the cause to which these hemorrhages were most frequently attributed (30.0%). Subinvolution of the placental bed was noted in 13.3 percent of the patients, endometritis in 10.0 percent, pseudoaneurysm of the uterine artery in 3.3 percent, and excessively strong resumption of menses in 3.3 percent; no cause could be determined for 16.7 percent of the cases. Neither clinical signs nor causes differed by parity. CONCLUSION Secondary PPH is rare. Accurate diagnosis is based most often on histopathologic findings.
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Affiliation(s)
- Mathieu Dossou
- EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France
| | - Anne Debost-Legrand
- Department of Public Health, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Pierre Déchelotte
- Department of Fetal Pathology, University Hospital Center, Clermont-Ferrand, France
| | - Didier Lémery
- EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France.,Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Françoise Vendittelli
- EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France.,Department of Public Health, Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France.,AUDIPOG Sentinel Network, Medical university RTH Laennec, Lyon, France
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Esmaeillou H, Jamal A, Eslamian L, Marsousi V, Sarvi F, Kokab A. Accurate Detection of Retained Products of Conception after First- and Second-trimester Abortion by Color Doppler Sonography. J Med Ultrasound 2015; 23:34-8. [DOI: 10.1016/j.jmu.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Belachew J, Axelsson O, Eurenius K, Mulic-Lutvica A. Three-dimensional ultrasound does not improve diagnosis of retained placental tissue compared to two-dimensional ultrasound. Acta Obstet Gynecol Scand 2014; 94:112-6. [DOI: 10.1111/aogs.12502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 09/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Johanna Belachew
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Ove Axelsson
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Uppsala Sweden
| | - Karin Eurenius
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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Diniz CP, Araujo Júnior E, Lima MMDS, Guazelli CAF, Moron AF. Ultrasound and Doppler assessment of uterus during puerperium after normal delivery. J Matern Fetal Neonatal Med 2014; 27:1905-11. [DOI: 10.3109/14767058.2014.882895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Weissmann-Brenner A, Haas J, Barzilay E, Gilboa Y, Gat I, Gindes L, Mashiach R, Achiron R, Dulitski M. Added value of 3-dimensional sonography for endometrial evaluation in early puerperium. J Ultrasound Med 2013; 32:587-592. [PMID: 23525383 DOI: 10.7863/jum.2013.32.4.587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the uterine cavity within 48 hours of delivery using 2- and 3-dimensional sonography after normal vaginal deliveries, instrumental deliveries, exploration of the uterine cavity, and cesarean deliveries. METHODS A prospective study was performed in puerperal women with normal clinical examination findings. Measurements of the uterine length and width were taken in the midsagittal and coronal planes. Midsagittal measurements of the endometrium using 2- and 3-dimensional sonography and virtual organ computer-aided analysis were performed. Comparisons were made between normal and surgical vaginal deliveries, cesarean deliveries, and after exploration of the uterine cavity. RESULTS A total of 123 patients were examined. Seventy-seven patients had normal vaginal deliveries; 21 had assisted vaginal deliveries; and 25 had cesarean deliveries. Thirteen underwent exploration of the uterine cavity. The uterine volume increased significantly as the birth weight increased and after cesarean delivery (P < .05). No correlation was found between the endometrial volume and parity, birth weight, and mode of delivery, including no correlation with exploration. Five cases of placental residua were found in asymptomatic women. All delivered vaginally. None underwent exploration of the uterus. All had irregular echogenic masses in the uterine cavity with positive color Doppler findings. The endometrial thickness and volume were significantly higher in these patients. CONCLUSIONS Sonography along with Doppler assessment has added value in the clinical evaluation of the puerperal women, being able to also show residua in asymptomatic women. Three-dimensional sonography did not show an advantage over 2-dimensional sonography in the estimation of the puerperal uterus or residua.
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Affiliation(s)
- Alina Weissmann-Brenner
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, 5262000 Tel Hashomer, Israel.
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Lamy C, Zuily S, Perdriolle E, Gauchotte E, Villeroy-de-galhau S, Delaporte M, Wahl D, Morel O, Judlin P. Prise en charge des infections du post-partum. ACTA ACUST UNITED AC 2012; 41:886-903. [DOI: 10.1016/j.jgyn.2012.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Babarinsa IA, Hayman RG, Draycott TJ. Secondary post-partum haemorrhage: challenges in evidence-based causes and management. Eur J Obstet Gynecol Reprod Biol 2011; 159:255-60. [PMID: 21839573 DOI: 10.1016/j.ejogrb.2011.07.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/07/2011] [Accepted: 07/14/2011] [Indexed: 11/29/2022]
Abstract
Secondary postpartum haemorrhage (SPPH) is an important post-natal issue, whose significance is perceived differently between practices, settings and probably within cultures. It is generally less focussed upon, in contrast to its primary counterpart. Patients prefer that it is treated promptly, even when it is not life-threatening. Intensity of blood loss, and the lesser popularity of conservative management drive clinicians towards the active options. Remarkably, none of the current treatment options is based on any evidence. Suction evacuation of the uterus may be complicated by life-threatening complications and blood transfusion. There are a few guidelines, and probably no protocols. In this review, we highlight salient factors to take into consideration, and propose a locally adaptable flowchart, which may be of use to General Practice doctors, Community Midwives and Obstetricians.
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Affiliation(s)
- Isaac A Babarinsa
- The Women's Centre, Gloucestershire Hospitals NHS Trust, Gloucester GL1 3NN, United Kingdom.
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Ho M, Li TC, Su SY. The Association between Traditional Chinese Dietary and Herbal Therapies and Uterine Involution in Postpartum Women. Evid Based Complement Alternat Med 2011; 2011:918291. [PMID: 21584195 DOI: 10.1155/2011/918291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 11/17/2022]
Abstract
Background. Traditional Chinese postpartum care is believed to help in the recovery of women after delivery. Objective. This study investigated the association of elements in dietary and herbal therapy with uterine involution. Methods. Indices of uterine involution were measured ultrasonographically in 127 postpartum women between 4-6 weeks after delivery. A self-reported retrospective questionnaire was used to query women about their frequencies of taking herbal medicines and consuming special diets during the first month after delivery. Correlation coefficients were calculated to identify the associations, then the regression models were used to identify the predictors. Result. Among the herbal medicines and diet, consumption of Eucommia ulmoides (E. ulmoides) negatively correlated with the AP diameter of the uterus and the cavity. E. ulmoides was also the only predictor of maximum AP diameter of the uterus, AP diameter of the uterus 5 cm from the fundus, and the maximum AP diameter of the cavity. Moreover, consumption of Sheng-hau-tang was significantly correlated with anteverted uterus and was a predictor of anteverted uterus. Conclusion. E. ulmoides and Sheng-hau-tang positively correlated with the degree of uterine involution after delivery, implying that both therapies might possess the pharmacological efficacy of uterine contraction in postpartum women.
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Zubor P, Szunyogh N, Dokus K, Scasny P, Kajo K, Galo S, Biringer K, Krivus S, Danko J. Application of uterotonics on the basis of regular ultrasonic evaluation of the uterus prevents unnecessary surgical intervention in the postpartum period. Arch Gynecol Obstet 2010; 282:261-7. [DOI: 10.1007/s00404-009-1227-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 09/08/2009] [Indexed: 11/25/2022]
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Abbasi S, Jamal A, Eslamian L, Marsousi V. Role of clinical and ultrasound findings in the diagnosis of retained products of conception. Ultrasound Obstet Gynecol 2008; 32:704-707. [PMID: 18792059 DOI: 10.1002/uog.5391] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the role of clinical and ultrasound findings as predictors of retained products of conception (RPOC) in women with a suspicion of incomplete miscarriage. METHODS This was a retrospective study of 91 patients admitted for suspected RPOC after spontaneous first-trimester miscarriage who were evacuated surgically, and for whom histopathological reports were available. All the women underwent transvaginal sonography after their miscarriage. The decision to evacuate the uterus was based on vaginal bleeding, lower abdominal pain and/or sonographic findings of hyperechoic material or endometrial thickness more than 8 mm. Maternal age, gestational age, clinical signs and symptoms and sonographic findings were recorded. Clinical and sonographic findings were compared with the histopathological reports and the sensitivity and specificity of vaginal bleeding, abdominal pain and sonographic appearance of the endometrium for detecting the products of conception were assessed. RESULTS Histopathological analysis confirmed the presence of chorionic villi in 55 women (60%) and decidua in 36 (40%). Vaginal bleeding was more frequent in women with RPOC (P < 0.001), whilst lower abdominal pain was a more frequent symptom in those with decidua (P = 0.019). The ultrasound finding of hyperechoic material had a sensitivity of 78%, specificity of 100% and positive and negative predictive values of 100% and 75%, respectively, in predicting RPOC. Vaginal bleeding as a predictor of RPOC had a sensitivity of 93%, specificity of 50%, and positive and negative predictive values of 74% and 82%, respectively. The combination of hyperechoic material and/or vaginal bleeding increased the sensitivity to 98% and negative predictive value to 95%. There was no significant difference in endometrial thickness between the two groups. CONCLUSION The ultrasound finding of hyperechoic material is the best predictor for diagnosing RPOC. In the absence of hyperechoic material and vaginal bleeding, RPOC are extremely unlikely.
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Affiliation(s)
- S Abbasi
- Perinatology Division, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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