Uterine Dimensions Research Articles

Correlation between spinopelvic alignment and uterine dimensions in primary dysmenorrhea: A case-control study

Background. The high prevalence of primary dysmenorrhea (PD) among young females has prompted interest in exploring its multifactorial causes. One area of investigation is the relationship between musculoskeletal posture and gynecological health. Purpose. To examine the potential correlation between spinopelvic alignment and uterine dimensions in females with and without PD. Methods. This case-control observational study included 40 females with regular menstrual cycles, divided into two groups: 20 with PD (study group) and 20 without PD (control group). Spinopelvic alignment parameters, including thoracic kyphosis, lumbar lordosis, pelvic tilt, and pelvic torsion, were assessed using a 4D formetric device. Uterine dimensions, including corpus length and width, as well as cervix length and width, were measured by ultrasonography. Results. No significant correlations were found between the spinopelvic alignment and uterine dimensions in the study group with PD (p > 0.05). However, in the control group without PD, there were significant moderate negative correlations between uterine corpus width and thoracic kyphotic angle (p < 0.05), as well as between cervix length and pelvic tilt (p < 0.05). Conclusion. In females with PD, there are no significant correlations between spinopelvic alignment and uterine dimensions. In contrast, in females without dysmenorrhea, there are significant correlations between uterine corpus width and thoracic kyphotic angle, and between cervix length and pelvic tilt.

Spermatic and Uterine Dimensions in Mark and Luke's Parable of the Sower

AbstractThis article examines the language of seed reception within the Parable of the Sower in Mark and Luke. The paper argues that Mark's diction introduces reproductive terms into the seed figure and that Luke edits Mark to include even more distinctively gynaecological and reproductive terminology. The result is a parable in Luke that turns the audience into uterine receptacles of the seed/logos.

Feasibility of continuous intra-uterine pressure measurements during amnioreduction in twin-to-twin transfusion syndrome therapy

IntroductionThis work explores the feasibility of simultaneous and continuous intra-abdominal, intra-uterine, and arterial blood pressure measurements to examine the hemodynamic perturbation expected during therapeutic amnioreduction and to better understand the protective role of the placenta during that treatment. MethodsPatients with twin-to-twin transfusion syndrome were treated with fetoscopic laser ablation followed by amnioreduction. Intra-abdominal, intra-uterine, and mean arterial pressures were simultaneously recorded during amnioreduction performed in steps of 200 mL. Placental thickness and uterine dimensions were measured before and after amnioreduction by ultrasonography. ResultsUseful pressure recordings were obtained between volume reduction steps and short hands-off periods in four studies. Median amnioreduction volume was 1400 mL corresponding to a median uterine volume reduction of 1121 mL. Mean intra-uterine pressure significantly fell from 24.8 to 13.6 mmHg (p = 0.011) and intra-abdominal pressure significantly decreased from 13.4 to 9.2 mmHg after amnioreduction (p = 0.015). Uterine pressure recordings revealed transient contractions (A, in mmHg) following individual amnioreduction steps, which increased with fractional amnioreduction (F, no dimension) (A = 17.23*F + 11.81; r = 0.50, p = 0.001). DiscussionSimultaneous and continuous measurement of intra-abdominal, intra-uterine, and arterial blood pressures during amnioreduction is feasible. The dynamics reveal transient uterine contractions reaching levels comparable to those seen during childbirth which seem to oppose impending maternal hypovolemia by placental steal at the expense of temporarily reducing placental perfusion pressure and underline the importance of uterine and placental interaction.

Growth hormone therapy is associated with improved uterine dimensions in girls with Turner syndrome prior to oestrogen replacement.

Adult women with Turner syndrome (TS) have high rates of miscarriage, presumably due to the abnormal size and shape of the uterus. There is a paucity of data regarding the determinants of uterine volume (UtVol) in young girls with TS before the initiation of oestrogen replacement therapy (ERT). We performed a cross-sectional study on premenarchal girls with TS, aged 5-15 years, pubertal stage B1-B3, not having received ERT (n = 73) and 50 age-matched healthy controls. Anthropometric parameters and a history of growth hormone (GH) therapy (≥1 year) were noted. Uterine length (UtL), UtVol, and mean-ovarian-volume (MOV) standard-deviation scores (SDS) were determined from transabdominal ultrasonography data. Girls with TS had lower median UtVol-SDS (-1.07 vs. 0.86; p < .001), UtL-SDS (-3.72 vs. -0.41; p < .001) and MOV-SDS (-5.53 vs. 1.96; p < .001) compared to age-matched controls. Among TS girls, recipients of GH (n = 38) had higher UtVol-SDS (-0.63 vs. -1.39; p = .0001), UtL-SDS (-1.73 vs. -6.49; p < .0001) but similar MOV-SDS compared to nonrecipients (n = 35). Those with normal uterine volume for age (NUVA, n = 29) had earlier initiation (7.8 vs. 9.3 years; p = .03) and a longer duration of GH (3.71 vs. 2.14 years; p = .002) than those with low UtVol for age (n = 44). UtVol-SDS correlated with duration of GH (ρ = 0.411, p = .01) and negatively with age at GH initiation (ρ = -0.479, p = .003). In a model adjusted for pubertal status, karyotype and height-SDS, GH use could independently predict having NUVA (odds ratio: 5.09, confidence interval: 1.63-15.94, p = .005). GH therapy has a stimulatory effect on uterine dimensions in pre-and peripubertal girls with TS. Earlier initiation and longer duration of GH is important in TS girls before ERT.

ULTRASONOGRAPHIC MORPHOMETRIC ANALYSIS OF UTERUS IN NULLIPAROUS AND MULTIPAROUS FEMALES ATTENDING TERTIARY CARE HOSPITAL

Background: Uterus is considered as a major reproductive organ in women which is responsible for pregnancy and delivery of the foetus. The dimensions of the uterus can act as the markers for the reproductive health of the women. The dimension of the uterus deviates from the normal dimensions in the presence of any anomalies. Therefore, the uterine dimensions can help in predicting the reproductive health of the women and help in the treatment. Ultrasonography is an overexploited technique due to the key advantages it provides in diagnoses purposes. The uterine dimension can easily be measured by this technique. Aims and Objectives: To measures the uterine dimension using Ultrasonography of women lying in the age group of 15-45 years. Methods- Uterine dimensions of 200 nulliparous and parous women were measured in the study and comparison were made from the normal counterparts. Results: Women lying in 15-25 years of age were having the mean longitudinal length as 6.43±0.24 cm, mean Anteroposterior diameter as 2.96±0.33 cm and mean transverse diameter as 3.77±0.45cm. In age group of 26-35 years, the mean longitudinal length was 7.72±0.630, mean anteroposterior diameter was 3.59±0.42 cm and mean transverse diameter was 4.42±0.52 cm. In age group of 36-45 years the mean longitudinal length was 8.57±0.55, mean anteroposterior diameter was 4.12±0.45cm and mean transverse diameter was 4.93±0.46cm. Conclusion: Our study showed a significant increase in uterine dimensions with Age and Parity. These values are of immense importance for predicting and later on diagnosing any uterine pathology affecting its dimensions.

Türkiye’nin Trakya bölgesinde erken prepubertal gelişim ile takip edilen 367 çocuğun biyokimyasal klinik ve etiyolojik özellikleri

Background: Appearance of menarche before nine years of age, secondary sex characteristics before 8 in girls and 9 in boys is defined as Precocious Puberty (PP).&#x0D; Objective: The aim of this study was to describe etiologies, clinical findings, and compare anthropometric properties and biochemical characteristics of children with PP.&#x0D; Methods: In this single-centre study, 367 patients of whom medical records were reviewed diagnosed as premature thelarche (PT), premature adrenarche (PA), Central PP (CPP), and peripheral PP (PPP). The diagnosis was based on clinical, laboratory, and radiologic investigations and their follow-up.&#x0D; Results: During six years, 349 girls (%95,1) and 18 boys (%4,9) diagnosed as PP. The most common etiologies were CPP;127 (%34,6), PT;117 (%31,9), PA;112(%30,5) and PPP 11(%3), respectively. CPP group had significantly higher levels of height, weight, body mass index (BMI) and obesity/overweight incidence, estradiol (E2), basal luteinizing hormone (LH), peak LH, and peak LH/ follicle-stimulating hormone (FSH) ratio and higher uterine dimensions compared to the PT group while the PT group had significantly higher levels of peak FSH compared to the CPP group (p

Fertility-sparing surgery for diffuse adenomyosis: a narrated, stepwise approach to the Osada procedure

To equip reproductive surgeons with an approach to the Osada procedure and critical prophylactic hemostatic measures that optimize perioperative outcomes. Stepwise demonstration of the Osada procedure with narrated video footage. Definitive management of symptomatic adenomyosis requires hysterectomy. However, adenomyomectomy can improve symptoms and restore anatomy while maintaining fertility potential. Limited but comparable perioperative outcomes exist for minimally invasive methods of adenomyomectomy, and most involve resection of focal, not diffuse, adenomyosis. Among the literature involving resection of diffuse adenomyosis using minimally invasive methods, relatively small volumes of resected tissue are reported and none include obstetric outcomes. Most published reports for excision of diffuse adenomyosis involve laparotomic resection, likely because of specific intraoperative challenges curtailed by this approach. In response, a laparoscopic-assisted laparotomic approach was developed in 2011 by Dr. Hisao Osada, a reproductive surgeon in Japan. This procedure involves aggressive excision of adenomyotic tissue with prophylactic hemostatic techniques and subsequent uterine wall reconstruction using a triple-flap method. Compared with other excisional methods for diffuse adenomyomectomy, the Osada procedure has the best reported obstetric outcomes. A 37-year-old nulliparous female presented with pelvic pain, bulk symptoms, abnormal uterine bleeding, and infertility. Physical examination demonstrated a 20-week, bulky uterus with limited bimanual mobility. Her endometrial cavity was inaccessible because of marked anatomic distortion. Magnetic resonance imaging revealed marked abnormality of her endometrial contour because of a 15 cm adenomyoma with diffuse adenomyomatous tissue in the posterior uterine compartment. Prior interventions included a trial of combined hormonal contraceptive, leuprolide acetate, and tranexamic acid. She was interested in fertility-sparing adenomyomectomy to address symptoms and fertility potential and chose to proceed with the Osada procedure. She was optimized medically with oral and parenteral iron therapy to bring her hemoglobin from 55-111 g/L preoperatively. Institutional review board approval and informed consent from the patient were obtained. The Osada procedure was performed using the following 8 surgical steps: Systemic administration of tranexamic acid was also administered intraoperatively. Perioperative blood loss, anatomic normalization, symptom remediation, and maintenance of fertility potential. Perioperative blood loss was minimal, 469 g of adenomyotic tissue was extracted, and discharge was on postoperative day 2 without any complications. Three months later, cyclic pain and bleeding had improved markedly, ultrasound confirmed Doppler flow throughout the uterus, hysterosalpingogram demonstrated a nonobliterated endometrial cavity and tubal patency, and magnetic resonance imaging confirmed normalized uterine dimensions measuring 11 × 7 cm from 19 × 10 cm. Most literature supports waiting at least 6-12 months and until demonstration of normalized uterine blood flow in the operated area before attempting conception. Fertility-sparing excision of diffuse adenomyosis can be achieved safely using the Osada procedure, following the 8 discrete steps demonstrated in this video. Reproductive surgeons can reference this video to teach and maintain this important procedure.

Long-term treatment of dienogest with symptomatic adenomyosis: retrospective analysis of efficacy and safety in clinical practice

ABSTRACT Objective: To evaluate the efficacy and safety of dienogest (DNG) in women with symptomatic adenomyosis.Methods: Women with symptomatic adenomyosis were included in this retrospective observation study. Group 1 (maximum uterine dimension ≥ 100.0 mm) began DNG after 4 months of GnRH-a administration, Group 2 (maximum uterine dimension < 100.0 mm) received DNG with no prior GnRH-a treatment. All women were assessed for their pain symptoms, uterine size, adverse effects and laboratory hematology at baseline and every 6 months during the treatment.Results: 123 women were enrolled in this study, in Group 1 (71 women) with severe uterine enlargement, the median VAS score was 80 mm prior to GnRH-a administration and 10, 10, 10, 20, and 20 mm, respectively, after 0, 6,12,18, and 24 months of DNG treatment. The mean uterine volume decreased from 262.9 ml to 104.7 ml after GnRH-a therapy, and slowly increased from 104.7 ml to 139.5 ml after 24 month-treatment of DNG. Another 52 women with mild uterine enlargement received DNG without prior GnRH-a administration, median VAS score was 70 mm at baseline and decreased to 20, 20, 10, and 10 mm at 6,12,18, and 24 months. The mean uterine volume slightly decreased from 157.9 ml to 153.3 ml after 24 months of DNG treatment (p > 0.05). All laboratory parameters were in the normal range.Conclusions: DNG is effective and well tolerated as a long-term treatment for symptomatic adenomyosis, and it can be used as maintenance therapy after discontinuation of GnRH-a administration.

SONOGRAPHIC MEASUREMENT OF NORMAL UTERINE DIMENSION IN NULLIPAROUS ADULTS

Background: Normal uterine size determination of nulliparous women is very important for the diagnosis of the various uterine pathology. There are different pathologies of uterus but before describing the pathological aspects normal dimension has to be defined. Ultrasound is the first tool for scanning female pelvis pathology. The objective of the study is determining the normal uterine dimension in the nulliparous adults and correlate with the age, height, weight and BMI. Methods: The study was conducted in Department of Radiology and Imaging College of medical sciences, Bharatpur. Patient presenting with any other symptoms than pelvic cause are included in study with age group (15-25years). All ultrasound examinations were performed using Toshiba Aplio 500. A cross-sectional study is conducted among the 49 patients in College of Medical Sciences, Bharatpur, over the period of one year (November 2020 to October 2021). Results: Present study showed the mean length, AP diameter, width and volume of the uterus in nulliparous women between the ages of 15-25years. The mean length is 6.88±0.75cm, mean AP diameter is 3.89±0.44cm, mean width is 4.2±0.50 and mean volume is 61.41±16.96 cc. The present study showed the strong correlation between the weight of the patient and uterine dimension, however there is no significant correlation could be established between the age, height and body mass index of the patients with volume uterine dimension. Conclusions: Normal uterine dimension in Nepalese population is similar to the Nigerian, Scandinavian and Iranian population however the dimensions are smaller than the European population which may be due to the body habitus and genetic factors. There is significant correlation between the weight of patient and volume of the uterus.

Reproducibility of MRI Features of Uterine Leiomyomas: A Study on Interobserver Agreement and Inter-Method Agreement With Surgery.

To evaluate interobserver agreement in the interpretation of different MRI features of uterine leiomyomas (UL) according to observers' experience, and to assess the inter-method reproducibility (MRI versus surgery) regarding the International Federation of Gynecology and Obstetrics (FIGO) classification. Retrospective study including UL patients who underwent MRI and surgical treatment. Four blinded observers (2 vs >10 years of experience) assessed UL regarding dimensions and volume; inner and outer mantles; FIGO classification; vascularization; degeneration; and diffusion-weighted imaging features. Uterine dimensions and volume were calculated. FIGO classification as ascertained by observers was compared to surgical findings. Intraclass correlation coefficient (ICC) estimates were used for interobserver comparison of numerical variables, and kappa statistic for categorical variables. Thirty-five patients (26y-73y) with 61 UL were included in the interobserver analyses, and 31 patients (54 UL) had available data allowing retrospective surgical FIGO classification for assessment of inter-method reproducibility. Both groups of observers had good to excellent agreement in assessing UL (ICC = 0.980-0.994) and uterine volumes (ICC = 0.857-0.914), mantles measurement (ICC = 0.797-0.920), and apparent diffusion coefficient calculation (ICC = 0.787-0.883). There was substantial agreement for both groups regarding FIGO classification (κ = 0.645-0.767). Vascularization, degeneration and restricted diffusion had lower agreement, varying from reasonable to moderate. Inter-method agreement was reasonable (κ = 0.341-0.395). Interobserver agreement of MRI for UL was higher for quantitative than qualitative features, with a little impact of observers' experience for most features. MRI agreement with surgery was reasonable. Further efforts should be taken to improve interobserver and inter-method reproducibility for MRI in this scenario.

Prostaglandin and antigestagen in pyometra bitches: vascular and stereological effect.

SummaryEffects of conservative treatment on uterine blood flow and morphometric findings are still unknown in bitches. Thus, this study aimed to compare uterine changes of pyometra bitches subjected to distinct modes of treatment. Pyometra bitches were assigned to: OHE (ovariohysterectomy immediately after diagnosis), Aglepristone (days 1, 2 and 8) and Associative (aglepristone treatment coupled with cloprostenol for 7 days) groups. After 9 days, bitches were ovariohysterectomized. Before surgery, uterine area was measured ultrasonographically and the uterine artery Doppler velocimetry analyzed blood flow velocity and indexes. Uterine horns were classified according to resistance index (RI) as more compromised and less compromised. Endometrial vasculature was quantitatively evaluated by color flow Doppler. Blood samples were collected to determine nitric oxide (NO) concentrations. Histological uterine structures were quantified by stereology and VEGF-A (vascular endothelial growth factor) and eNOS were (endothelial nitric oxide synthase) immunohistochemically analyzed. Aglepristone and Associative groups had lower uterine area and vascularization, and higher blood flow velocity and indexes compared to OHE group. Less compromised horn of Associative group had higher blood flow velocity compared to OHE group. Aglepristone group presented lower inflammatory infiltrate and larger uterine stroma. Associative group had lower volume density and absolute surface of endometrial cysts and lower VEGF-A expression for glandular epithelium and stromal cells. Blood NO and e-NOS immunostaining were not different among groups. In conclusion, association between aglepristone and prostaglandin is more effective in decreasing uterine vascularization and modulating uterine blood flow. Moreover, associative therapy promotes marked morphological changes.Lay summaryThis research compared two medical protocols of treatment for uterine infection (pyometra) in bitches, using a hormone blocker (anti-progesterone aglepristone) solely or in association with a uterine contraction inducer (prostaglandin; associative therapy). After treatment, bitches were gonadectomized and a microscopic analysis of uterine blood vessel formation and uterine tissue elements were performed as well as uterine blood flow evaluation through Doppler ultrasonography. According to vascular resistance, uterine horns were additionally classified as more compromised and less compromised. Both treatment protocols led to reduction of uterine dimensions and vascularization, and higher blood flow compared to untreated bitches. Less compromised uterine horn of the associative treatment had higher blood flow compared to untreated bitches. The hormone blocker treatment had lower inflammatory cells and larger uterine histological structure, while associative treatment had less uterine pathological cysts and lower blood vessel formation. The associative therapy is effective in decreasing uterine vascularization and modulating uterine blood flow as well as reestablishing endometrium structure in bitches with uterine infection.

Uterine dimensions and intrauterine device malposition: can ultrasound predict displacement or expulsion before it happens?

Intrauterine devices (IUDs) are the most commonly used method of long-acting reversible contraception. IUD malpositions are described as expulsion, embedding, displacement, and perforation, which may cause contraception failure, organ injury, hemorrhage, and infection. The aim of the study was to evaluate the relationship between displacement and IUD positioning in the uterus, and uterine dimensions as measured using transvaginal ultrasonography. Three-hundred and eighty-four patients who had TCu380A devices inserted at a tertiary hospital were evaluated at insertion and at 1month, 3months, and 6months after insertion. At the insertion visit, demographic characteristics, history of menorrhagia, dysmenorrhea, previous IUD displacement, and obstetric history were recorded. Transvaginal ultrasonographic measurement of the uterine cavity, uterine length, uterine width, cervix length, cervix width, transverse diameter of the uterine cavity, the distance between the tip of the IUD and the fundus, and endometrium were measured to evaluate IUD displacement. Sixteen of 384 patients had displacement. There were significant differences in times between last pregnancy outcomes and IUD insertion and dysmenorrhea history (p = 0.004 and p = 0.028, respectively). Among TCu380A users, women with 7.5mm IUD endometrium distances had a higher risk for displacement with a sensitivity of 81% and specificity of 37.5% (AUC: 0.607, 95% CI 0.51-0.70). Women with uterus width less than 41.5mm were more likely to have displacement with a sensitivity of 53.8% and a specificity of 75% (AUC: 0.673, 95% CI 0.60-0.75). IUD endometrium distance and uterus width are important parameters for displacement for TCu380A.

Relation between uterine morphology and severity of primary dysmenorrhea.

Objective:This study aimed to evaluate whether uterine dimensions including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness measurements have a role in the severity of primary dysmenorrhea in virgin girls.Materials and Methods:Enrollment included 90 virgin girls suffering from primary dysmenorrhea. The girls were divided into three groups according to the severity of dysmenorrhea, which was determined by the visual analog scale (VAS). Patients with VAS scores of 8-10 comprised the severe primary dysmenorrhea group (n=30), 4-7 the moderate primary dysmenorrhea group (n=30), and 1-3 the mild primary dysmenorrhea group (n=30). Uterine characteristics including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness were measured by a high-resolution four-dimensional ultrasound device with real-time capacity. They were recorded to determine if they can be predictors of dysmenorrhea severity.Results:Girls with severe primary dysmenorrhea were more likely to complain of midline pain as opposed to mild and moderate cases with lateral or diffuse pain. None of the uterine characteristics on ultrasonography examination were significant for predicting the severity of primary dysmenorrhea. There were no significant positive correlations between the dysmenorrhea severity and uterine corpus length, cervix length, and uterine volume degree. Any combination of the measured uterine features was not predictive for determining the severity of dysmenorrhea.Conclusion:Ultrasonographic measurements of uterine dimensions in virgins have low accuracy for predicting the severity of pain in primary dysmenorrhea.

Association of uterine dimensions and route of contained morcellation following laparoscopic hysterectomy.

The aim of this study was to determine if uterine dimensions on preoperative imaging are associated with route of contained morcellation during laparoscopic hysterectomy. This is a prospective cohort study of patients undergoing laparoscopic hysterectomy and requiring morcellation for specimen extraction from March 2017 through August 2019. A contained extraction system was inserted and manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction. A total of 47 patients were treated. Median age was 47 (range 38-70). Morcellation was performed vaginally for 29 patients (61.7%), abdominally for 13 patients (27.7%), and via combined approach for 5 patients (10.6%). The combined group had the highest frequency of patients who were black (vaginal: 24%, abdominal: 31%, combined: 100%; P=0.005), the longest median total operating time (vaginal: 167 minutes, abdominal: 183 minutes, combined: 268 minutes; P=0.006) and the longest median time of uterine morcellation (vaginal: 14 minutes, abdominal: 37 minutes, combined: 85 minutes; P<0.001). There was strong evidence of a positive correlation with time of uterine morcellation for both largest uterine diameter (Spearman's r: 0.62, P<0.001) and uterine volume (Spearman's r: 0.70, P<0.001). These associations remained consistent after multivariable linear regression models that were adjusted for route of morcellation, hysterectomy type, and BMI (both P<0.001). Larger uterine dimensions are associated with increased total operating and morcellation times. Uterine size and volume on preoperative imaging were not associated with route of morcellation, but there was a trend towards failed vaginal extraction when uterine dimensions exceeded 16 centimeters.

Effect of uterine dimensions on live birth rates after single embryo transfer in infertile women

Research questionDo uterine size parameters measured by baseline transvaginal ultrasound predict live birth after single embryo transfer (SET) of a high-quality blastocyst? DesignRetrospective cohort study including women undergoing their first SET between August 2010 and March 2014 at a large university hospital reproductive centre. The effects of baseline uterine dimensions on live birth rate (LBR) were analysed while controlling for confounding effects. ResultsA total of 437 nulliparous and 70 parous women were included. The nulliparous group had lower body mass index (BMI) (24.4 ± 5.1 versus 25.9 ± 4.5 kg/m2; P = 0.015) and a higher number of fibroids (0.4 ± 1.0 versus 0.2 ± 0.5; P = 0.005) than the parous group. While controlling for confounding effects, none of the uterine parameters appeared to be a significant predictor of LBR among nulliparous and parous women (P > 0.05 in all cases). A subsequent analysis of endometrial length was done, whereby the endometrial lengths were divided into quartiles (20.0–32.2 mm; 32.3–36.5 mm; 36.6–40.0 mm; 40.1–54.0 mm). After controlling for confounders, the shortest quartile in the nulliparous group had a significantly lower LBR (P = 0.02) than the other groups. Receiver operating characteristic curves suggested that endometrial cavity length and cervical length did not aid clinically. ConclusionUterine parameters do not have a clinically useful impact on LBR after SET of a blastocyst in infertile women. The use of baseline endometrial length to predict live birth is no better than chance, while cervical length only predicts failure to live birth.

Sonographic Evaluation of Uterine Dimensions in Postpartum Women of Reproductive Age-Study from Enugu, Southeast Nigeria

Introduction: Uterine involution, a physiological process in which the uterus reverts to prepregnant size, occurs during puerperium. The latter is a time of substantial maternal risk. Ultrasound is considered the most appropriate tool in monitoring the progression of uterine involution because it is cheap, convenient and repeatable with no radiation risk. Aim: To sonographically evaluate the involution of the uterus and uterine cavity in postpartum women in Enugu, Nigeria. Materials and Methods: This was a prospective longitudinal cohort study on 400 postpartum women at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Transabdominal ultrasonography to measure uterine dimensions was done on day 1, day 3 and day 42 of puerperium using a 3.5-5 MHz curvilinear probe of a portable ALOKA ultrasound machine. Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) software version 20.0. The uterine dimensions were expressed as mean±standard deviation and student's t-test analysis was used to compare the values for day 1, day 3 and day 42 of puerperium. Regression analysis was carried out to measure the relationship between uterine measurements on days 1, 3 and 42. A p-value of &lt;0.05 was considered statistically significant. Results: The mean longitudinal, anteroposterior and transverse diameters of the uterus at day 1 were 14.51 cm, 8.54 cm and 10.97 cm, respectively. The corresponding values for day 42 were 8.27 cm, 4.78 cm, and 6.22 cm. The uterine diameters decreased significantly as puerperium advanced (p&lt;0.001). The mean uterine cavity diameters also decreased significantly as puerperium advanced (p&lt;0.001). There was significant regression between longitudinal diameters of both uterus and uterine cavity on days 1 and 3 but not between days 3 and 42. Conclusion: This study has established a normal range of diameters for the uterus and uterine cavity on day 1, day 3 and day 42 of puerperium. It can serve as reference data for further studies in the study area.

2003 Association of Pre-Operative Uterine Dimensions and Success of Contained Morcellation Following Minimally Invasive Hysterectomy

Study Objective To determine if uterine dimensions on pre-operative imaging are associated with success of contained morcellation during minimally invasive hysterectomy. Design Canadian Task Force Classification Level of Evidence II-2 Setting Surgical patients in a single metropolitan academic institution. Patients or Participants Patients undergoing laparoscopic or robotic hysterectomy and requiring morcellation for specimen extraction from March 2017 through April 2019 Interventions At the completion of surgery, a contained extraction system was inserted, and the specimen was placed within the bag. Manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction. Morcellation times were recorded. Medical records were reviewed to abstract demographic and clinical data. Measurements and Main Results A total of 39 patients were treated. Median age was 47 (range 25 – 70) and mean length of stay was 0.74 days. There were no conversions to laparotomy, readmissions, or surgical site infections within 30 days after surgery. Morcellation was performed vaginally for 24 patients (61.5%), abdominally for 10 patients (25.6%), and via combined approach for 5 patients (12.8%). Largest uterine dimension on imaging was median 12.6 centimeters (range 6 – 19.7) in the vaginal group, 11.9 (7.2 – 20) in the abdominal group, and 16.4 (14.1 – 23) in the combined group (p=0.046). Both morcellation time (mean 19.7 minutes vaginal, 38.9 abdominal, 78.6 combined; p Conclusion Larger uterine dimensions are associated with failed vaginal extraction, and pre-operative imaging can assist with surgical decision-making. Providers need to be deliberate when choosing route of specimen removal, as morcellation and total operating time significantly increase when vaginal morcellation is unsuccessful.

Reduced uterine volume after induction of puberty in women with hypogonadism.

Adequate uterine growth is an essential component of pubertal induction with exogenous oestradiol in those with hypogonadism. Poor uterine development will render the individual vulnerable in the context of fertility. We assessed uterine size using ultrasound in those who had undergone pubertal induction treatment compared with a reference group who had experienced spontaneous puberty. This is a single-centre, retrospective, cross-sectional study of women who underwent pubertal induction compared with a reference group. Ninety-five women with hypogonadism who had previously undergone pubertal induction and were receiving maintenance oestrogen replacement as adults were recruited: 48 women with Turner syndrome, 32 with premature ovarian insufficiency and 15 with gonadotrophin deficiency. The reference group consisted of 35 nulliparous women attending with male factor subfertility with a normal pelvis on ultrasonography. Pelvic ultrasound was performed by a single observer. Uterine dimensions (total length, anterior-posterior (AP), transverse, uterine volume and fundal cervical AP ratio (FCR) measurements) were recorded. Clinical details were also recorded. Those with hypogonadism had significantly reduced uterine dimensions compared with the reference group (uterine length 64mm vs 71mm P=<.05, uterine volume 28.9mL vs 43.9mL P=<.05). All women in the reference group attained a mature uterine configuration with a FCR >1, compared with 84% of those with hypogonadism (P=.01). A total of 24% and 48% of the diagnostic group had total uterine length and uterine volume measurements less than the 5th percentile of the reference group, respectively. In a subgroup of 22 women in whom serum oestradiol concentrations could be analysed, there was a positive correlation between this parameter and uterine volume. Despite standard oestrogen therapy, uterine growth is often compromised in those with hypogonadism. Uterine health has historically been overlooked in pubertal induction protocols; however, with increasing options for fertility treatment, adequate uterine development is crucial. Given the variation in uterine size witnessed, a more tailored approach to treatment with regular monitoring of uterine dimensions should be advocated.

Sonographic Study of Normal Uterine Size in Reproductive and Postmenopausal Age in Iraqi Women and related with Parity

Aim: The study included sonographic assessment of normal uterine size in non-gravid adult females at reproductive and postmenopausal women and its relation with parity. The anatomical variations of uterus particularly those concerning the body of uterus are well Known in medical literature. Data on uterine dimensions in parous (prim parous or multiparous) and nulliparous women are vital for public health consideration as the presence of uterine pathology effectively reflects the status of fertility and other gynecological condition in general. The last few decades, sonography has become the most important imaging modality for the study of the uterine pathology The estimation of uterine size has been widely reported by several authors from different parts of the world. Material and methods: this study included 150 non gravid female subjects were distributed into five age groups A(20-29), B(30-39),C (40-49), D(50-59), E(60-69), each group was divided into nulliparous, primiparous and multiparous women were examined sonographically because of abdominal or pelvic problem unrelated to uterus. All groups were subjected to transabdominal technique of uterine examination with a 3.5MHZ transducer. The length, width and anteroposterior diameter of uterus were calculated. The uterine volume was calculated using ellipsoid algorithm. These dimensions correlated with age and parity status of each study groups. Results: The length means increased at 20-49 age and decrease in 49-69 age. Increase the total means of the length of each group was related to parity, nulliparous (5.68±1.24), primiparous (6.15±1.72) and multiparous (7.28±1.33). Depth and width showed mild significant differences between study age groups. Width and depth were recorded increase related to party in all study groups. Uterus volume of uterus decreased with age groups, while total uterus volume increased in multiparous than the primiparous and nulliparous women. Means endometrial thickness was decreased with age groups and total means correlated with parity, in nulliparous (5.46±2.59), primiparous (5.51±3.13) and multiparous (6.35±3.07) Conclusion: Present study the uterine length and total volume showed clear increase with age and correlated with parity, while the width and depth show little changes with age but clear changes related to parity. The endometrial thickness was decreased with age and increased significantly with parity.

Motherwort injection in preventing post-abortion hemorrhage after induced abortion: A multi-center, prospective, randomized controlled trial

ObjectiveThe aim of this study was to evaluate the efficacy and safety of motherwort injection (MI, Yi mu cao) in preventing post-abortion hemorrhage and promoting uterine retraction after induced abortion surgery. MethodsIn this multi-center randomized controlled trial undertaken between September 2014 and August 2016, 408 child-bearing age women who underwent induced abortion surgery and randomly assigned to two groups: MI group who received intramuscular MI treatment (n = 207) and no-treatment group (n = 201). The volume of vaginal bleeding and its duration were used as primary end points; and uterine size and dimension were measured as secondary end points. Blood coagulation indices, routine blood and adverse events were recorded to evaluate the safety. ResultsThe efficacy analysis was based on 366 patients. No significant difference were found in baseline characteristics between the two groups (P > 0.05). The amount of vaginal bleeding and duration of bleeding were significantly reduced in MI group compared with on-treatment group in Full Analysis Set (FAS) and Per Protocol Set (PPS) populations (P < 0.001). The volume and perimeter of the uterine dimensions in MI group were smaller than no-treatment group (P < 0.001). No significant abnormal vital signs were observed. Only 1 case of mild, transient erythema was found in MI group. ConclusionsMI could reduce post-abortion hemorrhage and improve uterine retraction in women undergoing surgical induced abortion, without serious adverse events. It was a safe and effective treatment in preventing post-abortion hemorrhage after induced abortion.