Abstract
Objectives: Practitioners are continuously concerned with the differences between the normal puerperium and the uterine involution after operated deliveries. This prospective observational study pays attention to the uterine involution period after the instrumental or operative delivery and compares the results with those observed in uncomplicated labour. Methods: Over two postpartum months 66 women after normal (48) and complicated (18) labour were examined for repeated uterine parameters. The analysis was performed using SPSS version 21. Results: There was no statistically significant difference between the median uterine size parameters or the uterine artery indices after the normal delivery and instrumental/operative uterine manipulations during the involution period, except for a faster declining trend observed in anteroposterior diameter within the first month after normal labour. The diastolic notch was more frequent in early puerperium after complicated labor, but less frequent later. The diastolic notch did not appear in all the postpartum women even two months after labour. There was evidence of more frequent gas detected in the pathological rather than in the physiological group. Conclusion: Postpartum uterine involution is not impacted by instrumental or operative procedures. After complicated labour gas appearance is more common, but it does not necessarily indicate the presence of endometritis or retained placental tissues.
Highlights
Considerable scholarly attention has been drawn to the involution of the uterus in recent years
Practitioners are continuously concerned with the differences between the normal puerperium and the uterine involution after complicated deliveries: operative evacuation of retained placental tissues (RPT), caesarean delivery or postpartum endometritis
A total of 66 women after delivery were examined from 2013 through 2016: 48 underwent uncomplicated vaginal delivery and none of them suffered from any complications during puerperium; 18 women were diagnosed with obstetrical pathology (2 patients with the uterine scar after previous caesarean section (C/S)), 7—after a current caesarean delivery, 6 with RPT which had to be removed manually (3 patients) and instrumentally (3 patients), 3 women suffered from postpartum endometritis
Summary
Considerable scholarly attention has been drawn to the involution of the uterus in recent years. Practitioners are continuously concerned with the differences between the normal puerperium and the uterine involution after complicated deliveries: operative evacuation of RPT, caesarean delivery or postpartum endometritis. The reports on these conditions are still sparse and scans are relatively old and poor quality [14] [15] [16]. There is a small body of work describing the uterine ultrasound differences found in patients after normal or complicated labour from the earliest puerperium (within two hours after labour) until 8 weeks of postpartum period with original sonograms. A few studies include continuous Doppler measurements of uterine arteries during the uterine involution period, or the scope of the examination is very narrow [1] [11] [12] [13]
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