Uterine Wall Thickness Research Articles

GnRHa active immunity regulates expression of LHR protein and development of uteri in ewes

To investigate the LHR protein expressions in the ovine uteri and LH secretion, and to determine whether the alarelin active immunity affects the uterine development in ewes. Twenty-eight ewes (five to six months) were assigned to four experimental groups. Animals in EG-1, EG-2 and EG-3 were subcutaneously injected with 200, 300 and 400 µg alarelin antigens (day 0 and 14), respectively. Animals in the CG were injected with 2.0 mL solvent (day 0 and 14). Uterine horns were dissected aseptically on day 70. The serum LH concentrations were measured using ELISA. Tissue slices were observed and photographed under optical and electron microscopes. The images were measured using Images software. The results showed that the expressions of LHR protein in EGs increased. The level of LHR protein in EG-3 was higher than that in CG (P < 0.05). Serum LH concentrations in EGs were lower than that in CG from day 21 to day 45 (P < 0.05). Uterine weights in EG-1, EG-2 and EG-3 reduced by 4.66%, 10.20% and 16.63% (P<0.05), respectively. Uterine wall thickness (UWT) in EG-1, EG-2 and EG-3 reduced by 1.41%, 5.84% and 8.75% (P < 0.05), respectively. The endometrial epithelium thickness (EET) in EG-1, EG-2 and EG-3 decreased too (P < 0.05). The uterine wall shrank obviously and the glandular cavity reduced. The microvilli shortened. The mitochondria and mitochondrial crista decreased. Summarily, alarelin immunity could promote LHR protein expression in the uteri, and decreased serum LH concentrations, including decreased EET, UWT and uterine weights, could affect the uterine microstructure and ultrastructure, resulting in the inhibition of uterine development dose-dependently.

Immunohistochemical expression of vascular endothelial growth factor receptors Flt1 and KDR in the endometrium during the estrus cycle in albino rats

Background Angiogenesis is an important process in endometrial development and embryonic implantation and is regulated through vascular endothelial growth factor (VEGF); its receptors Flt1 and KDR. Aim This work aimed to study the immunoexpression of VEGF receptors (VEGF-Rs) in the endometrium at different ages and reproductive phases and correlate them with the histological profiles in these phases. Materials and methods Seventy female albino rats were included in this study. They were divided into seven groups of 10 rats each: one group consisted of rats in the prepubertal period at age 4–6 weeks; five groups consisted of rats in the reproductive period at age 6–10 months, which were divided according to estrus cycle phases into proestrus, estrus, metestrus, diestrus, and pregnant groups; and the sixth group consisted of rats in the postmenopausal period at age 15–18 months. The uteri of all rats were removed and processed for staining with H&E and were subjected to immunohistochemical staining for Flt1 and KDR. For morphometric measurements, uterine wall thickness and Flt1 and KDR optical density in the endometrial surface epithelium, glandular epithelium, stromal cells, and endometrial endothelial cells were measured using image analysis. Results were statistically compared. Results The expression of VEGF-Rs was highest in the pubertal age group with marked expression of these receptors in the proestrus phase followed by the estrus phase. This supports the role of sex hormones, especially the estrogen hormone, in regulating VEGF-R expression. The Flt1 receptor was predominantly expressed in endometrial and stromal cells as well as in blastocysts, whereas the KDR receptor was predominantly expressed in endometrial endothelial cells. Comparison among all groups and then between each two groups revealed statistically significant differences in the measured morphometric parameters. Conclusion The upregulation of Flt1 and KDR could be involved in the regulation of endometrial endothelial cell proliferation and in increase in endometrial vascular permeability, especially at implantation sites.

Image-guided brachytherapy for cervical cancer: Analysis of D2 cc hot spot in three-dimensional and anatomic factors affecting D2 cc hot spot in organs at risk

To analyze the D2 cc hot spot in three-dimensional CT and anatomic factors affecting the D2 cc hot spot in organs at risk (OARs). Thirty-one patients underwent pelvic CT scan after insertion of the applicator. High-dose-rate treatment planning was performed with standard loading patterns. The D2 cc structures in OARs were generated in three dimensional if the total equivalent dose in 2Gy exceeded our defined dose limits (hot spot). The location of D2 cc hot spot was defined as the center of the largest D2 cc fragment. The relationship between the hot spot and the applicator position was reported in Digital Imaging and Communication in Medicine coordinates. The location of sigmoid, small bowel, and bladder D2 cc hot spots was around the endocervix: The mean location of sigmoid hot spot for lateral view was 1.6cm posteriorly and 2.3cm superiorly (Y, 1.6 and Z, 2.3), small bowel was 1.6cm anteriorly and 2.7cm superiorly (Y, -1.6 and Z, 2.7). The mean location of bladder hot spot was 1.6cm anteriorly and 1.6cm superiorly (Y, -1.6 and Z, 1.6). These hot spots were near the plane of Point A (X, 2.0 or -2.0; Y, 0; and Z, 2.0). The mean location of rectal hot spot was 1.6cm posteriorly and 1.9cm inferiorly (Y, 1.6 and Z, -1.9). D2 cc hot spot was affected by uterine wall thickness, uterine tandem position, fibroids, bladder fullness, bowel gas, and vaginal packing. Because of the location of the D2 cc hot spots, larger tumors present a challenge for adequate tumor coverage with a conventional brachytherapy applicator without an interstitial implant. Additionally, anatomic factors were identified which affect the D2 cc hot spot in OARs.

Sonographic assessment of first stage of labor progress (ULTRASONIC PARTOGRAM)

PurposeTo assess the role of ultrasound in the follow up of the progress of labor in terms of uterine wall thickness in its upper and lower segments. MethodsThis is a prospective cross sectional study conducted in the period from March 2012 to August 2012. Included a total of 43 low risk pregnant women at Dallah hospital, Riyadh, Kingdom of Saudi Arabia. Trans-abdominal ultrasound was used to measure the uterine wall thickness. ResultsWith the progress of labor, the upper uterine wall progressively thickened, while the lower uterine segment progressively thinned. A significant change in uterine wall thickness was found with every 2cm cervical dilatation. A sono-partogram was developed. There was no significant difference in uterine wall thickness with respect to gravidity. The upper/lower uterine wall thickness ratio may also be valuable in the assessment of the progress of labor. We found that, measuring the uterine wall thickness by trans abdominal US is a non invasive method which has the potential role for assessing the progress of labor especially in high risk pregnancies when digital examination carries the risk of ascending infection or bleeding as in patients with preterm labor, premature rupture of membranes or ante-partum hemorrhage. ConclusionsTrans-abdominal US is a new non invasive method and has the potential for assessing the progress of labor. A sono-partogram is very useful in the follow up and evaluation of the progress of labor.

OC13.01: Sonographic findings in adenomyosis after insertion of levonorgestrel intrauterine device

The aim of this study (2006–2011) was to assess whether the sonographically detectable morphological alterations of the myometrium induced by adenomyosis changed after insertion of the LNG-IUD. 120 premenopausal symptomatic patients (menorrhagia, severe dysmenorrhea) with minimum five sonographic findings (globular shaped uterus, myometrial cysts (2–6 mm), inhomogeneous myometrium, indistinct borders to a myometrial mass, indistinct endometrial stripe, subendometrial linear striations, hyperechoic myometrial nodules, asymmetric thickening of the anterior or posterior uterine wall, minimal mass effect on the endometrium or serosa) of adenomyosis were enrolled into the study. Before and at 3, 6 and 12 months after insertion of the LNG-IUD all the patients underwent transvaginal sonography which evaluated uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, thickness of uterine wall and asymmetric myometrium, presence of myometrial hyperechoic striation. Color Doppler can be utilized in all cases to help distinguish between leiomyomas and adenomyosis. 23 patients become amenorrheic at 6 months and at 12 months—43 patients become amenorrheic. 50 patients had a significant reduction in menstrual bleeding at 12 months. 4 patients need to extract the LNG-IUD because of important bleeding. Dysmenorrhea was significantly alleviated in all 78 patients. We observed a significant decrease in uterine volume (170.3 ± 10.4 mL vs. 104.5 ± 8.2 mL) and reduction in asymmetric wall thickness (29.3 ± 1.9 mm vs. 17.2 ± 2.8 mm). However sonographic signs of adenomyosis such as myometrial cystic areas and hyperechoic striation did not disappear. The accuracy of transvaginal ultrasound in the detection of adenomyosis is highly operator dependent. After insertion of a LNG-IUD in patients with adenomyosis, uterine volume decreased, the myometrial wall shrank and symptoms were significantly alleviated. However sonographic signs of adenomyosis did not seem to disappear completely.

Normal and abnormal uterine involution in cows monitored by ultrasound

Success in cattle breeding is one of the most important goals in livestock farming and it requires particular attention when it is about securing unobstructed reproduction. Final goal in cattle breeding is to produce one live calf per year, which will likewise enhance milk production through successful pregnancy. The aim of our research was to monitor uterine involution speed with aid of ultrasound device and make records when cows are ready to be inseminated again, which cows need more time to complete involution and how many cows will have uterine disorders and require therapy. The experiment was carried out from October 2009 until the end of January 2010. In our experiment 50 cows were included and 412 transrectal ultrasound examinations were performed. Cows were transrectally examined, starting from 6th day postpartum until 52 days postpartum. Speed of uterine involution has been monitored through decrease of uterine horn diameter and wall thickness. Cows with normal puerperium have completed involution in the period from 38 - 45 days postpartum, while those with abnormal puerperium needed more time to complete it or required therapy of disturbed uterine status. In total 48% of cows had normal uterine involution, 52% of cows had some abnormalities in involution and 10% of cows in experiment required therapy. With continuous monitoring of reproductive tract in cattle with ultrasound it is possible to timely detect right time for first insemination postpartum, decrease period of open days or to detect abnormalities in uterine health status and treat it.

Studies of GnRH-A Active Immunization Effects on LH and FSH Secretion and Histostructure of the Ovary and Uterus in Rabbits

Abstract The objective of the study is to investigate the effects of active immunization against gonadotropin releasing hormone agonist (GnRH-A) on secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the pituitary, and to observe the histological structures and development about ovaries and uteri in female rabbits. 24 female rabbits (Oryctolagus cuniculus) were divided randomly into 4 groups (n=6), namely, experimental group I (EG-I), experimental II (EG-II), experimental III (EG-III), and control group (CG). Rabbits were subcutaneously injected with 1.0 mL GnRH-A (alarelin) antigen respectively at concentrations of 100, 100 and 50 ug mL” 1 respectively, in EG-I, EG-II and EG-III. Alarelin antigen was re-injected in EG-II and EG-III with the same dosage on 20 d. CG was a blank. The ovarian and uterine samples were collected aseptically at the end of the experiment of 70 d. The tissue slices were observed under light and electron microscopes. Serum concentrations of LH and FSH were measured with ELISA. The results showed that serum LH concentrations in EG-II and EG-III reached the peak levels on 50 and 40 d respectively, and LH level in EG-II exceeded other 3 groups on 50 d (i<>0.05). FSH level in EG-II was higher than those in EG-I, CG (PO.01) and EG-III (PO.05) on 40 d. GnRH-A could increase the number of primary follicles, enlarge the primary follicle vertical diameter (PFV) and primary follicle transverse diameter (PFT), and promote growth and maturation of follicles. The endometrial epithelium thickness (EET) and uterine wall thickness (UWT) in three EGs were less than that in CG (P<0.05). GnRH-A can increase the quantities of mitochondrial cristaes, cortex granules in cytoplasm, broaden and lengthen zona pellucidas and microvilli of oocytes. It also enlarged nuclei of ooxytes and mitochondria, thereby it promoted the development of oocytes. Re-injection of 100 ug alarelin antigen enhanced the secretion of LH and FSH. GnRH-A promoted the growth and maturation of ovaries and follicles, suppressed uterine development, and also influenced histostructure of ovaries and uteri in female rabbits.

INCIDENCE OF ADENOMYOSIS AND THEIR ASSOCIATIONS WITH OTHER UTERINE WALL PATHOLOGIES IN HYSTERECTOMY SPECIMENS

BACKGROUND: Adenomyosis is a gynaecological condition in which there occurs an ectopicendometrial tissue in myometrial layer of uterine wall. Adenomyosis is one of the most common causesof abnormal uterine bleeding.OBJECTIVE: To determine the incidence of adenomyosis and their association with other uterinepathologies in hysterectomy specimens in northern district of Khyber pukhthunkhwa.MATERIALS AND METHODS: This descriptive study was conducted in Gynecology department andPathology department of Saidu Medical College / Saidu teaching hospital Swat. The study period wasfrom June 2013 to June 2016. A total of 250 hysterectomies were included in the study. The inclusioncriteria was only hysterectomies specimens of any age, whereas exclusion criteria were autolysedspecimen. A minimum of two sections and a maximum of six sections were taken from the uterine wall.Sections 5 micron thick were stained with H&amp;E and reported by histopathologists. The data wasanalysed in Statistical Package for Social Sciences (SPSS) version 16 for frequencies with percentagesand mean with standard deviation.RESULTS: A total of 250 hysterectomies were included in this study with mean age of 37.5±8.47 yearsand age range was from 25 to 65 years. The incidence of adenomyosis was 34.8% amongst 250hysterectomies specimens and was the second common lesion where as leiomyoma was the firstcommon lesion. The most common age group in adenomyosis was between 35-45 years 43(49.42%)cases followed by 25-35 years 32(36.78%) cases etc. Adenomyosis was present in 84(95.40%) caseswith endometrial wall thickness of more than 2.5 millimeter.CONCLUSION: Adenomyosis was the second commonest lesion in hysterectomy specimen and wassignificantly associated with other uterine pathologies.KEY WORDS: Hysterectomy, Adenomyosis, Uterine wall thickness.

Intraluminal Pressure in a Uterine Tamponade Balloon Is Curvilinearly Related to the Volume of Fluid Infused

We studied the effect of incremental infusion of fluid volume in a tamponade balloon on intraluminal pressure and uterine blood flow. Following placental delivery, a tamponade balloon was inserted into the uterus and incrementally inflated. Intraluminal pressure was measured at incremental volumes. Ultrasound was used to determine positioning of the catheter, uterine wall thickness, and uterine artery velocity waveforms in eight patients. Pressure-volume relationship was estimated by regression analysis. Significance was p < 0.05. There was a significant exponential curvilinear relationship between balloon pressure and infused volume at the maximum volume for each subject ( R = 0.64, p = 0.01). Doppler ultrasound showed that at or above 1000 mL inflation volume, 5/6 patients (83%) showed reversal of uterine artery diastolic flow. At maximal inflation volume, all of the patients with reversed diastolic flow had intraluminal pressure less than systolic blood pressure. Intraluminal pressure increases curvilinearly as volume of an intrauterine tamponade balloon is increased. The mechanism of action of tamponade balloons is likely related to a reduction in uterine artery perfusion pressure. Whether this is the result of direct compression of the artery in the lower segment or due to wall conformational changes is not clear.

Nonpuerperal Uterine Inversion Associated with Endometrial Polyp

Introduction: Current literature fails to describe an accurate incidence of nonpuerperal uterine inversion as a consequence of its rarity. However, uterine inversion may cause ischemia with subsequent necrosis and infection requiring immediate resolution with little or no prior experience. Case: A 68-year-old multiparous white woman, without prior gynecological surveillance, went to the emergency room complaining of vaginal bleeding. She had had vaginal spotting for the past 3 years. Examination revealed an approximately 10-cm mass filling the vagina. She was admitted for further study and surgery programming. A few hours later she developed abdominal pain, fever, and the mass protruded from the vulva. It was decided that she should immediately undergo surgery. The mass was removed by twisting through the vaginal route. At laparotomy, a doughnut appearance of an inverted uterus with tubes and ovaries abnormally positioned within the crater was observed. Exerting pressure from below and bilateral traction on the round ligaments failed to restore the uterus to normal position. An incision through the full thickness of the posterior uterine wall at the constriction site ring level was performed with combined traction from below, which was successful. Total hysterectomy with bilateral adnexectomy followed without difficulties. Pathological diagnosis was endometrial polyp. Conclusions: Nonpuerperal uterine inversion is a rare condition and the diagnosis is often made during surgery. Ultrasonography and magnetic resonance imaging have been shown useful as diagnostic tools. The authors review the surgical techniques described in the literature. (J GYNECOL SURG 26:215)

Human Uterine Wall Tension Trajectories and the Onset of Parturition

Uterine wall tension is thought to be an important determinant of the onset of labor in pregnant women. We characterize human uterine wall tension using ultrasound from the second trimester of pregnancy until parturition and compare preterm, term and twin pregnancies. A total of 320 pregnant women were followed from first antenatal visit to delivery during the period 2000–2004 at the John Hunter Hospital, NSW, Australia. The uterine wall thickness, length, anterior-posterior diameter and transverse diameter were determined by serial ultrasounds. Subjects were divided into three groups: women with singleton pregnancies and spontaneous labor onset, either preterm or term and women with twin pregnancies. Intrauterine pressure results from the literature were combined with our data to form trajectories for uterine wall thickness, volume and tension for each woman using the prolate ellipsoid method and the groups were compared at 20, 25 and 30 weeks gestation. Uterine wall tension followed an exponential curve, with results increasing throughout pregnancy with the site of maximum tension on the anterior wall. For those delivering preterm, uterine wall thickness was increased compared with term. For twin pregnancies intrauterine volume was increased compared to singletons (), but wall thickness was not. There was no evidence for increased tension in those delivering preterm or those with twin gestations. These data are not consistent with a role for high uterine wall tension as a causal factor in preterm spontaneous labor in singleton or twin gestations. It seems likely that hormonal differences in multiple gestations are responsible for increased rates of preterm birth in this group rather than increased tension.

MRI Determined Uterine Wall Thickness in Pre- and Post-Menopausal Patients: A Guide for Safer Hysteroscopic Surgery

MRI Determined Uterine Wall Thickness in Pre- and Post-Menopausal Patients: A Guide for Safer Hysteroscopic Surgery

Diagnosis of complete Cul‐De‐Sac obliteration (CCDSO) by the MRI jelly method

To evaluate the usefulness of MRI jelly method (jelly method). Fifty-five patients (32.7 +/- 5 years old) with endometriosis, treated with laparoscopic surgery between January and June 2005 with preoperative MRI using the jelly method. In imaging by the jelly method, 50 mL of jelly used for ultrasound was injected into the vagina, and 150 mL of jelly diluted twice with tap water was injected into the rectum. MRI were inspected for the following seven findings: (Finding 1) Uterine position (anteflexion or retroflexion); (Finding 2) Thickness of the posterior uterine wall (adenomyosis uteri); (Finding 3) Ascites in the Douglas' pouch; (Finding 4) Elevated posterior uterine fornix; (Finding 5) Thickening of the "Haustra"; (Finding 6) Elevated anterior rectal wall; and (Finding 7) Douglas' pouch lesion visualized as a high-intensity area on a T1-weighted image. The latter four findings were enhanced with the jelly method. These seven findings were examined for their correlations with video findings of adhesion during surgery. CCDSO was present in 30 of 55 patients. These seven findings had accuracies of 69.1%, 70.9%, 72.7%, 74.5%, 56.4%, 83.6%, and 81.8% respectively. Findings 6 and 7 showed high accuracy. These two findings could only be obtained using the jelly method, indicating the usefulness of this method for diagnosing CCDSO.

MORPHOLOGICAL AND MORPHOMETRICAL STUDY OF CYCLOPHOSPHAMIDE-INDUCED CHANGES IN THE OVARY AND UTERUS IN THE SYRIAN MICE

Summary The objective of this research was to evaluate the cause of fertility reduction after chemotherapy. Cyclophosphamide is a common chemotherapy and immunosuppressive agent used for the treatment of a wide range of neoplastic and some auto-immune diseases. In the present study, morphometrical changes in the ovary and uterus of 12 5-6-week-old female Syrian mice after intraperitoneal injection of 75 mg cyclophosphamide/kg BW were assessed. Control animals (n = 8) were injected with sterile distilled water using similar method. The results of this study revealed that cyclophosphamide eliminated almost more than 50% of the primordial follicles (PMF) reserve. The mean ± SE number of PMF in the control group was 1210 ± 135 compared to 464 ± 55 in the test group. The mean number of secondary, tertiary follicles and corpora lutea also showed significant (P<0.05) reduction in the treatment group. The histomorphometric studies also showed that the mean ± SE diameter of the ovary in the control group was 1703 ± 78 µm as compared to 900.9 ± 86 µm in the test group (P<0.01). The thickness of the uterine wall was also significantly different with a mean ± SE of 745.7 ± 13 µm in the control and 393.1 ± 23 µm in the test group. The mean ± SE thickness of endometrium in the control group was 392.1 ± 16 µm, whereas in the test group it was 194 ± 10 µm (P<0.001). The results of this study revealed that chemotherapy with cyclophosphamide causes destruction of PMF as well as other growing follicles; accordingly, the reproductive potential was negatively affected. The method used in this study can be most likely used as a sensitive and inexpensive tool to predict the damage to fertility caused by new chemotherapy protocols. In conclusion, chemotherapy brings about a) reduction in ovarian follicular populations, especially PMF, b) it causes reduction in diameter and size of ovary and c) decreases thickness of uterine wall, especially endometrium.

Dose distribution of modified heyman packing

Introduction. One of the treatment modalities of brachytherapy of endometrial carcinomas is the modified Heyman packing technique.The aim of the study is to assess the dose distributions of regular arrangements of modified Heyman packings. Materials and Methods. We reconstructed the catheters with biplane X-ray images and optimised the dose distribution with defining‘dose points’ the uterine wall thickness apart from the outermost left and right catheters. We fitted the reconstructed catheters with the diagnostic sagittal MR scan obtained prior to the first insertion. We checked the dose distribution defining ‘patients points’ on sagittal contour of the uterus. Results and Conclusions. The treatment plans optimised ‘on dose points and geometry’ resulted in a satisfactory dose distribution, however systematic overdosed and under-dosed regions have been experienced.

Permanently increased conductance of the murine uterine arcade after the first pregnancy

Mechanical forces due to increased blood flow during the first pregnancy might induce a permanently higher conductance of the uterine arcade. Number of endothelial and smooth muscle cells, cross-sectional area and wall thickness of the uterine artery were measured in nulliparous mice (n = 11) and until the 93rd day after parturition in primiparous mice (n = 44). Inner diameter and wall area were calculated. Three months after the first pregnancy, uterine artery wall thickness was not altered compared to nulliparous mice. In contrast, inner diameter increased 1.6-fold, wall area 1.5-fold and the numbers of endothelial and smooth muscle cells increased 1.5 times. These changes were completely stable during the whole observation period. The increased blood flow during the first pregnancy might be a mandatory mechanical stimulus for uterine arcade maturation. This physiological maturation process could result in abortion explaining the higher prevalence of unexplained pregnancy losses in primiparous women.

Assessment of Uterine Wall Thickness and Position of the Vascular Plexus in the Deep Myometrium: Implications for the Measurement of Depth of Myometrial Invasion of Endometrial Carcinomas

Accurate discrimination between FIGO stages IB and IC endometrial carcinomas has important prognostic and therapeutic implications, but depth of invasion as a percentage of myometrial thickness can be difficult to ascertain. In such cases, pathologists often presume that infiltration that reaches the arcuate vascular plexus (AVP) in the myometrium indicates >50% myoinvasion. The further assumption is sometimes made that the anterior and posterior uterine walls are of the same thickness. To our knowledge, neither supposition is based on published data. We performed a prospective study of myometrial thickness and the position of the AVP in 50 normal uteruses from patients aged 27 to 84 years. Myometrial thickness varied inversely with age (p < 0.0001); however, anterior and posterior wall myometrial thickness did not differ significantly in the cohort as a whole (p = 0.059) and in individual cases was highly correlated (p < 0.0001). The position of the AVP was variable. On average, its inner limit was situated at a depth of 47.3% of the thickness of the myometrium in both uterine walls, but the position varied between individuals and sometimes differed considerably between the anterior and posterior walls of the same uterus. The position of the AVP did not differ significantly with age. We conclude that carcinomatous infiltration well into or through the AVP usually signifies >50% myoinvasion; however, if infiltration barely extends into the AVP, the depth of invasion should be calculated with reference to the thickness of the myometrium in the opposite uterine wall.

Image-based intracavitary brachytherapy in the treatment of inoperable uterine cancer: Individual dose specification at specific anatomical sites

Purpose With advances in imaging studies, dose specification for uterine cancer can be defined at specific anatomical sites such as the myometrium or the serosal surface rather than at arbitrary points or milligram-hours. This report presents our experience with image-based brachytherapy for inoperable uterine cancer. Methods and materials Eight patients with organ-confined uterine cancer (2 Stage I GI, 3 Stage I G2, 3 Stage I G3) underwent definitive radiation therapy because of poor medical condition. All the patients underwent a CT or MRI scan of the pelvis before intracavitary application. Based on the size of the uterine cavity, a single-channel intrauterine applicator was selected for a small uterus, and a multiple-channel intrauterine applicator was used for a large uterus. A CT ( n=5) or MRI ( n=3) scan of the pelvis was performed with the applicator in place in addition to orthogonal pelvic films. Individualized dose specification was 75 Gy to the midmyometrium and limited to 50 Gy to the serosal surface of the uterus based on imaging information. Results Four patients with Stage I G1–2 disease had intracavitary brachytherapy alone. Four patients with Stage I G2–3 disease were treated with a combination of external pelvic radiation and intracavitary brachytherapy. Six patients had low-dose-rate brachytherapy, and 2 patients had high-dose-rate brachytherapy. Five patients had single-channel intrauterine brachytherapy, and 3 patients had multiple-channel brachytherapy. Based on the measurements of the uterine wall thickness by the imaging studies, the dose specification was prescribed to 1.5 cm lateral to the central axis of the uterus in 4 patients, 2.0 cm in 3 patients, and 2.5 cm in 1 patient. The medium followup time after radiation treatment was 38 months. Six patients are alive without evidence of disease, and 2 patients died of other causes. All patients had local control without major side effects. Conclusions Image-based brachytherapy based on individualized dose specification at specific anatomical sites can be done easily and provides excellent local control for inoperable uterine cancer.

Ultrasound measurements of uterine wall thickness in the third trimester in women with prior low transverse incisions were not significantly different from those of the control group

Objective: The aim of this study was to determine if third-trimester ultrasound measurements of the lower uterine segment could be a useful tool in predicting a safe trial of labor in patients with a prior low transverse incision.

Myometrial thickness during human labor and immediately post partum

Objective: Morphologic studies suggest dramatic, asymmetric uterine growth during pregnancy that is caused by muscle cell hypertrophy. This growth is most marked at the fundus. Our objective was to evaluate sonographically the in vivo changes in myometrial thickness during active labor, second-stage labor, and after delivery. Study design: Abdominal ultrasound scans were performed on 52 term pregnant women to investigate the dynamic changes in myometrial thickness during the active and second stages of labor and immediately after delivery. Twenty-six women (mean ± SEM gestational age, 39.09 ± 0.3 weeks) were in active labor (cervical dilatation >4 cm with regular uterine contractions). An additional 26 nonlaboring women (gestational age, 39.8 ± 0.2 weeks) provided control measurements. The myometrium was defined sonographically as the echo homogeneous layer between the serosa and the decidua. Myometrial thickness was measured at the low segment and mid anterior, fundal, and posterior uterine walls by the same observer. Myometrial thickness was also measured during uterine contractions and after artificial rupture of the amniotic membranes. All laboring women had uncomplicated labor patterns when studied and were delivered spontaneously. Results: The myometrium was significantly thinner during active labor compared with nonlabor at each site studied: midanterior (mean [±SEM] myometrial thickness, 5.8 ± 0.27 vs 8.83 ± 0.51 mm; t test, P < .001), fundus (mean myometrial thickness, 6.78 ± 0.32 vs 8.49 ± 0.35 mm; P = .0015), and posterior (mean myometrial thickness, 6.22 ± 0.34 vs 8.12 ± 0.30 mm; P < .001). However, myometrial thickness did not differ among sites within the two groups. The thickness of the low segment was not affected by labor status (nonlabor, 4.68 ± 0.48 vs labor, 4.66 ± 0.37 mm; P = .97). Similarly, the myometrial thickness of the anterior uterine wall was unaffected by contractions (no contractions, 5.56 ± 0.2 vs contractions, 5.68 ± 0.22 mm; t test, P = .654). There was no change in myometrial thickness measured immediately before and after rupture of the amniotic membranes, despite a significant decrease of the amniotic fluid index. There was significant thickening of the anterior and fundal myometrium during the second stage of labor after the fetal head descended to +3 station by digital examination (anterior, 12.99 ± 0.60 vs 5.8 ± 0.27 mm; t test, P < .001; fundus, 10.61 ± 1.63 vs 6.78 ± 0.32 mm; t test, P = .04). Valsalva maneuver (pushing) during contractions did not affect myometrial thickness at the fundus (between contractions, 10.61 ± 1.63 vs pushing, 10.76 ± 1.95 mm; t test, P = .99). Immediately after delivery, the myometrial thickness at the placental insertion site was the thinnest. After completion of the third stage of labor, the uterine fundus remained significantly thinner than the anterior and posterior walls (fundus, 27.37 ± 3.5 mm vs anterior, 40.94 ± 3.5 vs posterior, 42.34 ± 2.44; one-way analysis of variance, P = .02). Conclusion: There is significant and widespread thinning of the myometrium during active labor. Descent of the fetal head during the second stage of labor is associated with a significant relative thickening of the anterior and fundal myometrium. After delivery, the relationship reverses. These findings suggest the directionality of the expulsive force vectors (fundal dominance) is not determined by asymmetric myometrial growth but, rather, may be a function of increased “myometrial mass” that results from increased surface area at the fundus. (Am J Obstet Gynecol 2003;188:553-9.)