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Abstract
Postpartum hemorrhage is a leading cause of maternal mortality. Various methods can be used to evaluate the postpartum uterine cavity volume. This work aims to introduce a simple method for uterine postpartum cavity volume evaluation, called Postpartum Uterine Ultrasonographic Scale (PUUS), which could be used routinely. In this prospective study, 131 consecutive Caucasian patients were evaluated by using the PUUS method. The mean age was 27.72 years (ranging from 15 to 42). Patients were examined in the same time intervals: within the first 24-48 hours after delivery in case of vaginal delivery, and within the first 48-72 hours, in case of cesarean delivery. Patients with PUUS grades 2, 3, or 4 were reexamined daily until the PUUS grade declined to 1 or 0. The PUUS method evaluated the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). The PUUS grade of uterine involution varied with the day of examination, gestation, and parity. In this article, a novel method of evaluating uterine postpartum involution titled PUUS is introduced. This method standardized uterine cavity involution in a numerical fashion. We hope that the PUUS scale could further be used to decrease the morbidity and mortality of women due to postpartum hemorrhage.
Highlights
Postpartum hemorrhage is a leading cause of maternal mortality worldwide [1,2,3]
The Postpartum Uterine Ultrasonographic Scale (PUUS) grade varied with the gestation (IG, IIG, IIIG, IVG, VG, VIG, VIIG, VIIIG, IXG, and XG): 0.44, 0.51, 0.7, 0.71, 0.55, 0.16, 0, 0, 1, 1, respectively (Tables 3, 4)
Multiple gestations exhausted the uterine muscle so that postpartum involution required a longer time, and PUUS grade was higher during the first postpartum days in patients with multiple gestations
Summary
Postpartum hemorrhage is a leading cause of maternal mortality worldwide [1,2,3]. Postpartum uterine evaluation after delivery is extremely important. Poor uterine tone accounts for about 80% of all cases of primary postpartum hemorrhage [2]. Postpartum hemorrhage itself may not be preventable, early identification of blood loss and mobilization of resources may prevent adverse outcomes [3]. Ultrasonographic evaluation of the postpartum uterus may reveal a closed cavity, hematometra, or debris. Diniz et al reported that the uterine cavity was filled with some sort of material in 72.9% of the patients in the initial puerperium (initial 48 hours) whose uteri were examined through ultrasound and uterine artery Doppler [5]. There is a massive difference between 36% of women on day 1 and 72.9% of women within the first 48 hours postpartum; further research is required
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