Uterine Dimensions Research Articles

Phthalates exposure and uterine fibroid burden among women undergoing surgical treatment for fibroids: a preliminary study

To examine the association between phthalate exposure and two measures of uterine fibroid burden: diameter of largest fibroid and uterine volume. Pilot, cross-sectional study. Academic medical center. Fifty-seven premenopausal women undergoing either hysterectomy or myomectomy for fibroids. None. The diameter of the largest fibroid and uterine dimensions were abstracted from medical records. Spot urine samples were analyzed for 14 phthalate biomarkers using mass spectrometry. We estimated associations between fibroid outcomes and individual phthalate metabolites, sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP), and a weighted sum of anti-androgenic phthalate metabolites (∑AA Phthalates) using linear regression, adjusting for age, race/ethnicity, and body mass index. Fibroid outcomes were also examined dichotomously (divided at the median) using logistic regression. Most women were of black ethnicity, overweight or obese, and college educated. In multivariable models, higher levels of mono-hydroxyisobutyl phthalate, monocarboxyoctyl phthalate, monocarboxynonyl phthalate, mono(2-ethylhexyl) phthalate, mono(2-ethyl-5-hydroxyhexyl phthalate) (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), ∑DEHP, and ∑AA Phthalates were positively associated with uterine volume. Associations were most pronounced for individual DEHP metabolites (MEHHP, MEOHP, MECPP), ∑DEHP, and ∑AA Phthalates. For example, a doubling in ∑DEHP and ∑AA Phthalates was associated with 33.2% (95% confidence interval 6.6-66.5) and 26.8% (95% confidence interval 2.2-57.4) increase in uterine volume, respectively. There were few associations between phthalate biomarkers and fibroid size. Exposure to some phthalate biomarkers was positively associated with uterine volume, which further supports the hypothesis that phthalate exposures may be associated with fibroid outcomes. Additional studies are needed to confirm these relationships.

Maintenance of bone mass despite estrogen depletion in female common marmoset monkeys (Callithrix jacchus).

Estrogen depletion leads to bone loss in almost all mammals with frequent regular ovarian cycles. However, subordinate adult female common marmosets (Callithrix jacchus) undergo socially induced anovulation and hypoestrogenism without clinically apparent adverse skeletal consequences. Thus, we speculated that this non human primate might have evolved a mechanism to avoid estrogen-depletion bone loss. To test this possibility, we performed three experiments in which lumbar-spine (L5-L6) bone mineral content (BMC) and density (BMD) were assessed using dual-energy X-ray absorptiometry: (i) cross-sectionally in 13 long-term ovariectomized animals and 12 age- and weight-matched controls undergoing ovulatory cycles; (ii) longitudinally in 12 animals prior to, 3-4 and 6-7 months following ovariectomy (ovx), and six controls; and (iii) cross-sectionally in nine anovulatory subordinate and nine dominant females. In Experiments 1 and 3, plasma estradiol and estrone concentrations were measured and uterine dimensions were obtained by ultrasound in a subset of animals as a marker of functional estrogen depletion. Estrogen levels, uterine trans-fundus width, and uterine dorso-ventral diameter were lower in ovariectomized and subordinate females than in those undergoing ovulatory cycles. However, no differences were found in L5-L6 BMC or BMD. These results indicate that estrogen depletion, whether surgically or socially induced, is not associated with lower bone mass in female common marmosets. Thus, this species may possess unique adaptations to avoid bone loss associated with estrogen depletion.

Uterine dimensions in gravida 0 phase according to age, body mass index, and height in Chinese infertile women.

The aim of this study was to describe the size and the shape of gravida-0 uteri in infertile Chinese Han women according to age, height, and body mass index (BMI).Registered data obtained from the Department of Reproductive Medicine, Xiangya Hospital of Central South University, were collected and analyzed. The length, width, and anteroposterior diameter of the uteri of nonpregnant women aged 20 to 45 years were measured by transvaginal ultrasonography. Statistical analyses among different populations were conducted using a 1-way analysis of variance analysis or a Kruskal–Wallis H test.A total of 5726 primary infertile women were enrolled. The mean age of the sample group was 29.18 ± 4.22 years, and the mean BMI and the mean height of them were 21.51 ± 2.91 kg/m2 and 158.13 ± 4.71 cm, respectively. The mean uterine length, width, anteroposterior diameter, and L/W ratio were 49.33 ± 7.00 mm, 39.94 ± 7.23 mm, 44.95 ± 8.11 mm, and 1.2662 ± 0.2465, respectively. There were a statistically significant positive correlations between uterine length, width, anteroposterior diameter, and age in infertile women (all P < .001). Uterine L/W ratio gradually decreased with age, which was statistically significant (P < .001). The correlations between uterine length, width, anteroposterior diameter, and height were also considered statistically significant (all P < .001), while there was no correlation between L/W ratio and height. The results showed that uterine size and BMI had no statistical significance.The uterine length, width, and anteroposterior diameter gradually increased with increased age and height, but the increasing extents was different, and the uterine shape became rounder with age and had not changed with height in primary infertile women.

Three-dimensional reconstructed coronal plane in detection and differentiation of congenital uterine malformations

Background: Congenital uterine malformations develop during early embryogenesis, and their possible impact on female reproduction often represent a diagnostic and therapeutic challenge. In this study, the authors aimed to evaluate the possibility of detection and differentiation of Müllerian uterine anomalies on the basis of coronal plane obtained by three-dimensional transvaginal ultrasonography. Materials and Methods: The authors investigated 310 non-pregnant women who underwent three-dimensional ultrasound (3-D US) examination followed by the reconstructed three-dimensional images in the coronal plane. The patients were divided into two groups: infertile and unselected women. Results: Müllerian duct anomalies were diagnosed in 25 patients (8%). In the group of infertile patients the number of assessed anomalies was higher (16; 14.4%) as compared to the unselected patients (9; 4.6%). The prevalence of uterine anomalies was increased in the group of infertile patients. In the group of infertile patients, the length of uterine cavity was decreased compared to the unselected women (p = 0.0021). This difference was also visible in the case of nulliparous women from both groups (p = 0.0070). On the other hand, the thickness of fundal myometrium and the distance between the two internal tubal ostia did not vary among patients (p > 0.05). Conclusions: 3-D US represents a feasible and accurate technique for the detection and differentiation of congenital uterine malformations. Three-dimensional reconstructed coronal view could be used for the additional measurement of different uterine dimensions which were shown to differ between infertile patients and the control group, and according to the parity.

Total Laparoscopic Hysterectomy and Bilateral Salpingo-Oophorectomy for a 6095-g Myomatous Uterus in a Patient of the Jehovah's Witness Faith

Study ObjectiveTo demonstrate techniques for addressing the unique challenges for a minimally invasive approach to hysterectomy presented by a massive myomatous uterus. DesignTechnical video of an operation demonstrating the methods used to perform hysterectomy in this setting, highlighting such aspects as port placement (Fig. 1), uterine manipulation (Fig. 2), exposure, and vascular control (Figs. 3 and 4) (Canadian Task Force classification III). SettingAcademic tertiary care hospital. InterventionA 49-year-old woman elected to proceed with laparoscopic hysterectomy after years of suffering from bleeding and bulk symptoms from a massively enlarged myomatous uterus. A computed tomography scan estimated uterine dimensions of 32 × 27 × 24 cm, for a volume of >7000 mL (Fig. 5). Her surgical history included a ventral herniorrhaphy with mesh, and her body mass index was 43 kg/m2. She was a Jehovah's Witness, and thus blood transfusion was not an acceptable option for her due to a religious prohibition. Intraoperatively, the uterus extended deep into the pararectal and paravesical spaces on the right, from the caudad below the cervix (Fig. 6) to superiorly near the liver edge (Fig. 7). Measurements and Main ResultsLaparoscopic hysterectomy was successfully completed (Table), and the patient was discharged on the day after surgery. Final pathology revealed a 6095-g uterus with benign leiomyomata. She presented 9 days after surgery with nausea and vomiting, suspicious for an incarcerated hernia at the tissue extraction site. Her symptoms were ultimately determined to be due to either ileus or small bowel obstruction, which likely could have been managed nonoperatively with bowel rest and fluids. She stayed an additional 2 days after readmission and was then discharged, with no further complications. ConclusionsThe size of the uterus was once considered a barrier to the use of laparoscopy for hysterectomy, but experience has shown that the benefits of minimally invasive surgery are particularly relevant for large myomas [1–4], given that a vaginal approach is not feasible and that other risks, such as wound complications and venous thromboembolism, would be greater with the large incision required to perform the procedure by laparotomy. This video uses a particularly challenging case to demonstrate a roadmap for addressing myomas in laparoscopic hysterectomy through exposure and vascular control. Although the presentation focused on the initial steps of the procedure and not on uterine extraction, this patient's readmission highlights potential complications associated with various methods of tissue removal for very large specimens.

Relationship between copper IUD complications and ultrasonographic findings

Intrauterine device (IUD) is a widely used long-acting contraceptive method; however, the side-effects related to IUD may lead to method discontinuation. The aim of this study is to evaluate the relation between the most common side-effects of IUD use; mainly dysmenorrhea, menorrhaghia, pelvic cramping and the relation of these complications with the position of the IUD device within the cavity and uterine dimensions evaluated by transvaginal ultrasonography. Two hundred and eighty-four patients who had Cu-T380A IUD insertion at the Family Planning Clinic of a tertiary health center were evaluated at insertion and 6 and 12weeks after the insertion. Demographic characteristics, medical history, symptoms and findings of the gynecological examination were recorded. Transvaginal ultrasonographic measurement of the uterine dimensions, the distance between the tip of the Cu-IUD and the fundus, myometrium and endometrium were measured to evaluate the displacement of the IUD. The relationship between the symptoms and IUD displacement diagnosed by ultrasonographic examination were investigated. Two hundred and sixty-seven patients were followed-up for 12weeks as the remaining 16 had partial or complete IUD expulsion. A statistically significantly shorter uterine length was measured in patients who complained of menorrhagia in comparison to the ones without this complaint (54.27±6.11 vs 60.25±10.52mm, p=0.02) while uterine length was similar in patients with or without dysmenorrhea at 12weeks (59.60±10.25 vs 60.33±10.68mm, p=0.71). The distances between the tip of the IUD and the endometrium, myometrium and the uterine fundus, were statistically and significantly longer in patients who experienced pelvic cramping at 3rd month, showing a downward movement of the IUD. (Endometrium; 0.29±0.72 vs 0.45±0.35mm, p=0.02, Myometrium; 1.25±1.39 vs 2.38±2.26mm p<0.05, Fundus; 1.68±2.39 vs 2.92±1.78mm, p<0.05). A shorter uterine cavity length seems to be a predictor of menorrhagia in patients with Cu-T 380A IUD. Patients experiencing pelvic cramping with IUD are more susceptible for IUD expulsion as the downward movement of IUD is more prominent in these patients.

Quantification of the uterine involution and dimensions, hormonal response and reproductive performance of pyometric and healthy dairy cows treated with Dinoprost

The aim of the present study was to investigate the effects of a PGF 2α analogue (Dinoprost) on involution of the puerperal uterus, especially with pyometra during 35 to 45 days postpartum in multiparous high yielding Holstein dairy cows. At days 40 ± 5 postpartum, 1250 cows were ultrasonographically examined. Fifty cows were diagnosed as pyometric. Fifty pyometric and 50 clinically healthy cows were assigned randomly to one of four groups. Groups were: 1.) Pyometric+Dinoprost cows (PD, n = 25 treated with 25 mg of Dinoprost), 2.) Pyometric+Saline cows (PS, n = 25 treated with saline), 3.) Healthy+Dinoprost cows (HD, n = 25 treated with 25 mg of Dinoprost), and 4.) Healthy+Saline cows (HS, n = 25 treated with saline). All treatments were given intramuscularly. Ultrasonography was performed at the time of examination and 7 days later to evaluate changes in uterine diameter. Treatment with Dinoprost significantly reduced gross uterine diameter in PD in comparison to the PS group in the presence or absence (P4 concentrations <1 ng/ml) of an active corpus luteum. Dinoprost treatment did not decrease gross uterine diameter in groups HD and HS. Luminal diameter was significantly smaller in the PD than in the PS group. Pregnancy rate of PD was greater than PS cows (36% vs 20%, respectively). Days to first service (110 d vs. 140 d) and open days (160 d vs. 190 d) were shorter in PD cows than PS cows. It was concluded that injection of 25 mg of Dinoprost to pyometric cows had uterotonic effects in presence or absence of functional corpus luteum. Therefore, this treatment can help uterine involution in puerperal dairy cows affected by pyometra and consequently improved reproductive performance. Keywords: Cattle, Dinoprost, pregnancy rate, pyometra, uterine health

Determination of the reference values of uterine dimensions during ultrasound examination after late abortion performed according to fetal indications

Determination of the reference values of uterine dimensions during ultrasound examination after late abortion performed according to fetal indications

EP19.04: Sonographic appearance of the uterus in the early puerperium in vaginal vs Caesarean deliveries: a prospective study

Ultrasound may assist in the diagnosis of post-partum pathologies. However, data are scarce regarding the sonographic appearance of the uterus in the puerperal period, according to mode of delivery, and following third stage of labour abnormalities. We described uterine sonographic characteristics in early puerperium, following vaginal vs. Caesarean deliveries; and in women with abnormal third stage of labour, compared to uncomplicated vaginal delivery. This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates. Sonographic uterine dimensions (height, length and width), intracavitary thickness and its echogenicity (at level of fundus, mid-cavity and cervix) were recorded at less than and after 24 hours from delivery, and compared between women delivered vaginally and by Caesarean delivery. Among women delivered vaginally, data were analysed according to whether women underwent manual revision of the uterine cavity. Of the 99 women included in the study, 33 (33%) delivered by Caesarean section. Sonographic evaluations were taken at 15.4 (4.3-24.0) and 39.5 (28.8-108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24 hours from delivery. Postpartum sonographic evaluation of the uterus appears similar after vaginal and Caesarean deliveries.

Sonographic appearance of the uterus in the early puerperium in vaginal versus cesarean deliveries: a prospective study

Purpose: The purpose of this study is to compare uterine sonographic characteristics in early puerperium, following vaginal versus cesarean deliveries; and in women with abnormal third stage of labor, compared to uncomplicated vaginal delivery.Materials and methods: This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates; 66 women delivered vaginally and 33 delivered by cesarean section. Sonographic uterine dimensions (height, length, and width), intracavitary thickness and its echogenicity (at level of fundus, midcavity and cervix) were recorded at less than and after 24 h from delivery, and compared between women delivered vaginally and by cesarean section. Among women delivered vaginally, data were further analyzed according to whether women underwent manual revision of the uterine cavity.Results: Sonographic evaluations were taken at 15.4 (4.3–24.0) and 39.5 (28.8–108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24 h from delivery.Conclusions: Postpartum sonographic evaluation of the uterus appears similar after vaginal and cesarean deliveries.

Estimation of Uterine Size: How Accurate Are We?

To evaluate the accuracy of gynecologic surgeons at estimating uterine dimensions and weight. Six model uteri of various sizes were created to simulate the size and consistency of a uterus and displayed at 3 stations. The visual station (VS) comprised 2 specimens placed on an unmarked table. The laparoscopic station (LS) consisted of 2 model uteri, each placed in a separate simulated abdomen with a 0 degree laparoscope and 2 operative trocars with standard instruments. The blind weight station (BWS) consisted of blind palpation of 2 separately weighted models (heavy model [HM] and light model [LM]). Participants visually estimated the dimensions of each VS and LS models and blindly palpated the BWS models to estimate weight. Participants included 15 residents, 27 attendings, and 6 medical students. There was no difference in estimation accuracy regarding gender and age. For the VS and LS groups, participants underestimated all dimensions (VS variance = -15.0%; P < 0.001 and LS variance = -31.9%; P < 0.0001). Laparoscopic estimation was less accurate than direct vision (P < 0.0001). Attendings and residents equally underestimated the 3 dimensions visually (P = 0.46), but attendings were more accurate at estimating laparoscopic dimensions (-25.8% vs -41.1%; P = 0.0001). All groups overestimated model weights (HM variance, 92.5%; P < 0.001 and LM variance, 132.0%; P < 0.0001), with attendings more accurate than residents (39.7% vs 167.6%; P = 0.015 for HM and 52.0% vs 238.5%; P = 0.035 for LM). Gynecologic surgeons at all levels of training are inaccurate at estimating dimensions and weights. With surgical decisions often predicated on estimates, education is needed to improve estimation methods.

Ultrasonographic Evaluation of Uterine Involution in the Early Puerperium.

Purpose Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated. Methods Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured. Results The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account (p = 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery (p = 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p ≤ 0.01 and p = 0.04). Conclusion The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution.

Sonographic measurement of uterine dimensions in healthy nulliparous adults in Northwestern Nigeria

Background: Data on uterine dimensions in nulliparous women are vital for public health consideration as the presence of uterine pathology in nulliparous women effectively reflects the status of fertility and other gynecological conditions in general population. In the last two 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. Materials and Methods: Sonographic measurements of the uterine size in 400 nulliparous women with age ranging from 15 to 25 years were done during the secretory phase of the menstrual cycle, with the uterus measured in the anteroposterior (AP), longitudinal, and transverse planes. The uterine volume was calculated using the ellipsoid algorithm. Height and weight of the subjects were also measured. The data were analyzed with the aid of computer-based SPSS 20.0 software for Windows. Results: The mean AP diameter of the uterus was 3.3 cm with standard deviation of 0.3 while the mean longitudinal and transverse dimensions were found to be 6.4 cm ± 0.4 cm and 5.1 cm ± 0.2 cm, respectively. The mean uterine volume of the subjects was 57.4 cm 3 with standard deviation of ± 9.1. The uterine AP diameter showed poor correlation with age and weight but showed positive correlation with the height. Uterine length and width correlated positively with age and height but poorly correlated with weight of the subjects. Conclusion: Mean uterine dimensions in nulliparous women in Kano, Northwestern Nigeria, is virtually the same as that reported in Southwestern and north central parts of Nigeria, Iran, and Scandinavia but differ from those of other Europeans probably due to body habitus, racial, and genetic factors. This emphasizes the fact that normograms for each geographical area should be established.

Avoiding Morcellation of Laparoscopic Hysterectomy Specimens with Preoperative Measurement of Uterine Volume

Abstract Background: Hysterectomy is the second most common surgery among women, with ∼600,000 performed each year in the United States. Objective: The aim of this research was to identify preoperative factors associated with the ability to remove an intact uterine specimen transvaginally and avoid morcellation during laparoscopic hysterectomy. Materials and Methods: Patients were identified who underwent robotic-assisted total laparoscopic hysterectomy from January 9, 2008, to November 15, 2012. Charts were reviewed retrospectively for demographics. Preoperative uterine dimensions were used to calculate uterine volume. Subjects without preoperative uterine dimensions based on imaging were excluded. Demographics, indication for hysterectomy, need for uterine morcellation, histology, and actual uterine weight were noted. Statistical analysis was performed, using recursive partitioning and logistical regression analyses. Results: Four hundred and thirty-six patients were identified, with 136 excluded becaus...

Intrauterine device placement at 3 versus 6 weeks postpartum: a randomized trial

ObjectiveTo investigate whether early placement of an intrauterine device (IUD) at 3weeks after delivery, compared to placement at 6weeks, is associated with greater use at 3months postpartum. Study DesignThis prospective randomized, controlled trial enrolled inpatient postpartum women intending to use intrauterine contraception. Participants were assigned to an early (3week) or standard (6week) postpartum visit with IUD placement and were followed for 6months. We used transvaginal ultrasonography to confirm placement and measure uterine dimensions. We measured pain with IUD insertion and satisfaction with IUD timing using 100-mm visual analog scales. Data were analyzed based on randomization and actual timing of insertion (18–24 vs. 39–45days). ResultsBetween February 2012 and December 2013, 201 subjects were enrolled (early=101; standard=100). Most participants returned for IUD placement as scheduled; 70.1% (53/75) in the early group, 74.3% (58/78) in the standard group (p=.06). IUD use did not differ between groups at 3months (73/100, 73.0% and 73/97, 75.3%, respectively, p=.72) or 6months (80.3% and 82.8%, p=.71) amongst those women for whom follow-up was available. Women randomized to 6-week insertion were more likely to have resumed intercourse prior to the IUD appointment (15/64, 23.4% vs. 5/68, 7.3%, p=.01). Pain with insertion (19.9 vs. 25.1, respectively, p=.21) and satisfaction (89.6 vs. 93.4, respectively, p=.23) did not vary based on actual timing of insertion. ConclusionOffering IUD placement at 3weeks postpartum compared to standard scheduling at 6weeks does not result in increased use at 3months. However, early IUD placement is acceptable to women and without increased pain. ImplicationsThis study demonstrates that IUD placement as early as 3weeks postpartum is feasible. Larger studies are needed to evaluate risks and benefits of IUD placement at this early interval. While earlier timing does not result in increased IUD uptake, early placement should be explored as an option since many women resume intercourse before 6weeks.

Reproducibility and interoperator reliability of obtaining images and measurements of the cervix and uterus with brachytherapy treatment applicators in situ using transabdominal ultrasound.

To validate interoperator reliability of brachytherapy radiation therapists (RTs) in obtaining an ultrasound image and measuring the cervix and uterine dimensions using transabdominal ultrasound. Patients who underwent MRI with applicators in situ after the first insertion were included in the study. Imaging was performed by three RTs (RT1, RT2, and RT3) with varying degrees of ultrasound experience. All RTs were required to obtain a longitudinal planning image depicting the applicator in the uterine canal and measure the cervix and uterus. The MRI scan, taken 1hour after the ultrasound, was used as the reference standard against which all measurements were compared. Measurements were analyzed with intraclass correlation coefficient and Bland-Altman plots. All RTs were able to obtain a suitable longitudinal image for each patient in the study. Mean differences (SD) between MRI and ultrasound measurements obtained by RTs ranged from 3.5 (3.6) to 4.4 (4.23) mm and 0 (3.0) to 0.9 (2.5) mm on the anterior and posterior surface of the cervix, respectively. Intraclass correlation coefficient for absolute agreement between MRI and RTs was >0.9 for all posterior measurement points in the cervix and ranged from 0.41 to 0.92 on the anterior surface. Measurements were not statistically different between RTs at any measurement point. RTs with variable training attained high levels of interoperator reliability when using transabdominal ultrasound to obtain images and measurements of the uterus and cervix with brachytherapy applicators in situ. Access to training and use of a well-defined protocol assist in achieving these high levels of reliability.

Assessing changes to the brachytherapy target for cervical cancer using a single MRI and serial ultrasound.

To assess changes to the brachytherapy target over the course of treatment and the impact of these changes on planning and resources. Patients undergoing curative treatment with radiotherapy between January 2007 and March 2012 were included in the study. Intrauterine applicators were positioned in the uterine canal while patients were under anesthesia. Images were obtained by MRI and ultrasound at Fraction 1 and ultrasound alone at Fractions 2, 3, and 4. Cervix and uterine dimensions were measured on MRI and ultrasound and compared using Bland-Altman plots and repeated measures one-way analysis of variance. Of 192 patients who underwent three fractions of brachytherapy, 141 of them received four fractions. Mean differences and standard error of differences between MRI at Fraction 1 and ultrasound at Fraction 4 for anterior cervix measurements were 2.9 (0.31), 3.5 (0.25), and 4.2 (0.27) mm and for posterior cervix 0.8 (0.3), 0.3 (0.3), and 0.9 (0.3) mm. All differences were within clinically acceptable limits. The mean differences in the cervix over the course of brachytherapy were less than 1 mm at all measurement points on the posterior surface. Replanning occurred in 11 of 192 (5.7%) patients, although changes to the cervix dimensions were not outside clinical limits. There were small changes to the cervix and uterus over the course of brachytherapy that were not clinically significant. Use of intraoperative ultrasound as a verification aid accurately assesses the target at each insertion, reduces uncertainties in treatment delivery, and improves efficiency of the procedure benefiting both the patient and staff.

Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception.

Is small uterine cavity size as assessed by ultrasonography associated with bleeding problems or pain in nulligravid women using intrauterine contraception, or do other factors affect these parameters? Among levonorgestrel intrauterine system (LNG-IUS) users, small uterine cavity size is not associated with worsened clinical outcome, but is beneficial as women with the smallest cavity measurements were frequently amenorrhoeic and painless at the end of the first year but among copper intrauterine device (IUD) users, no associations between uterine cavity dimensions and clinical outcome were found. Nulligravid and nulliparous women have smaller uterine dimensions than parous women. Previously, many studies have revealed increased discontinuation rates of IUD use as a result of bleeding, pain or expulsion in these women, while recent studies with current models of IUS/IUDs indicate similar continuation and satisfaction rates irrespective of parity. In a pilot study, 165 adult nulligravid women requesting their first IUD between 1 January 2011 and 31 July 2012 were given a free choice between two IUDs with equal frames measuring 32 × 32 mm-the LNG-IUS 52 mg or a copper-releasing IUD. The women were followed for 1 year. The LNG-IUS was chosen by 113 women (68.5%) and the copper IUD by 52 (31.5%). Prior to insertion the women were interviewed concerning their menstrual characteristics and uterine cavity size was measured by 2-D ultrasonography. After insertion the women kept daily records of bleeding and pain for two reference periods of 90 days during the first year (Months 1-3 and 10-12). The correlation between uterine cavity measurements and numbers of days of bleeding/spotting and pain during the reference periods was analysed. Continuation rates were assessed and reasons for discontinuation as well as the effects of baseline participant characteristics on outcomes were analysed in regression models. Both uterine cavity size and baseline menstrual characteristics prior to IUD insertion predicted the numbers of days of bleeding/spotting and pain in LNG-IUS users. Women with small uterine cavity dimensions reported less bleeding/spotting in both reference periods and less pain in the second reference period compared with women with larger dimensions. Baseline scanty spontaneous menstrual bleeding prior to LNG-IUS use (OR 9.4, 95% CI 1.7-51.8, P = 0.01) and smoking (OR 7.8, 95% CI 1.8-33.8, P = 0.006) predicted amenorrhoea in the second reference period. Women with baseline dysmenorrhoea reported more pain with both IUDs. Continuation rates and reasons for discontinuation were similar with both IUDs. No sample size could be calculated to estimate the power as this was a pilot study. As the majority of women chose the LNG-IUS we did not achieve our initial aim of equally sized IUD groups and thus the size of the copper IUD group may have been insufficient to detect differences. These data further encourage promotion of intrauterine contraception among nulligravid women. Routine use of ultrasonography to assess uterine cavity dimensions prior to IUD insertion is not indicated. Supported by Helsinki University Central Hospital research funds, the Swedish Cultural Foundation in Finland and Finska Läkaresällskapet, who provided funds for J.K. O.H. serves on advisory boards for Bayer Healthcare, Gedeon Richter and MSD Finland (part of Merck & Co. Inc.) and has designed educational events with these companies. S.S. has lectured in educational events at Bayer and MSD Finland (part of Merck & Co. Inc.) and is a member of the Advisory Board for Contraception at MSD Finland. The other authors have no conflicts of interest to declare. www.clinicaltrials.gov, NCT01685164.

Bidimensional and Doppler ultrasonographic evaluation of postpartum uterine involution in the queen

The aim of this study was to describe bidimensional and Doppler ultrasonographic changes of uterine involution during normal feline puerperium. Secondary, the postpartum vaginal discharge was described. Twelve pregnant female cats were included in this study. After queening, vulvar discharge was grossly and microscopically examined daily. Bidimensional and Doppler ultrasonographic examinations of the uterus were performed on Days −4 to −2, 4, 11, 18, and 25 from parturition. Total uterine diameter, uterine wall thickness, uterine lumen contents, peak systolic velocity, end diastolic velocity, and resistance index of uterine arteries were measured. The cats presented serosanguineous vulvar discharge for a mean of 3 ± 1 days after parturition, and the cytology revealed 70% to 80% of erythrocytes, which progressively decreased up to Day 13. Immediately after parturition, there were less than 20% neutrophils, and this percentage gradually diminished to 0% to 1% at the end of the study. Uterine total diameter diminished up to Day 25 (P < 0.01), when ultrasonographic uterine dimensions were similar to that of anestrus. A progressive decrease of uterine wall thickness (P < 0.05), uterine lumen contents (P < 0.01), peak systolic velocity (P < 0.01), and end diastolic velocity (P < 0.01) was found throughout the study period. Conversely, resistance index increased during the first week after parturition (P < 0.01). It is concluded that the uterine artery blood flow progressively decreased during the first 25 days after parturition, which was associated with the bidimensional ultrasonographic regression of the organ. Although lochial discharge disappeared far before ultrasonographic involution, cytologic findings further corroborated the duration of this regression process.

The Relationship Between Dyspnea and Pulmonary Functions in Pregnancy: What About the Perinatal Outcome?

Pregnancy is a physiological entity that requires heavy mechanical adaptation and dyspnea is one of the frequent symptoms seen during pregnancy. There are many studies about pulmonary functions during pregnancy. But the effect of pulmonary functions on perinatal outcome is rarely reported. We want to impress especially perinatal outcomes. Methods: Seventy one primipar and normal pregnant women were examined in 8th, 20th and 34th gestational weeks, spirometry, diffusion capacity and muscle strength measurements were done followed by Borg dyspnea scale application. Uterine height and dyspnea score were measured accordingly. Type of delivery, the weight mother gained during pregnancy, birth weight of the baby, any malformation if present and the Activity, Pulse, Grimace, Appearance, Respiration (APGAR) score were recorded. The relationship of between dyspnea scores and these parameters was investigated. Results: There was no difference in pulmonary functions according to trimesters but uterine dimensions and dyspnea scores were significantly higher in the last trimester. In dyspnea group some spirometric parameters were significantly low. This group also had significantly high incidence of delivery with ceseraen section. Conclusion: Since respiratory functions are effected during pregnancy which accordingly determine the type of delivery, it’s necessary to pay special attention to pulmonary functions during this period.