1
|
Stader JM, Recker F, Tonguc T, Ramig O, Thudium M, Matlac D, Mutschler N, Egger EK, Mustea A, Küppers J, Essler M, Jenne J, Strunk HM, Conrad R, Marinova M. Clinical experience with shear wave elastography (SWE) for assessing healthy uterus in a transabdominal approach. Sci Rep 2024; 14:14473. [PMID: 38914622 PMCID: PMC11196258 DOI: 10.1038/s41598-024-65238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
Aim of the study was to evaluate the diagnostic performance and feasibility of transabdominal ultrasound shear wave elastography (SWE) in assessing sonoelastographic features of the uterus. Twenty-seven premenopausal women were enrolled between 2021 and 2022. Transabdominal SWE measured myometrial stiffness in various uterine segments. Additionally, tissue stiffness of the quadriceps femoris muscle and autochthonous back muscle was measured. Statistical analysis employed non-parametric tests, t test, and a robust mixed linear model. Stiffness values of the uterus and the two investigated muscle types exhibited a similar spectrum: 6.38 ± 2.59 kPa (median 5.61 kPa; range 2.76-11.31 kPa) for the uterine myometrium, 7.22 ± 1.24 kPa (6.82 kPa; 5.11-9.39 kPa) for the quadriceps femoris musle, and 7.43 ± 2.73 kPa (7.41 kPa; 3.10-13.73 kPa) for the autochthonous back muscle. A tendency for significant differences in myometrial stiffness was observed concerning the type of labor mode (mean stiffness of 9.17 ± 1.35 kPa after vaginal birth vs. 3.83 ± 1.35 kPa after Caesarian section, p = 0.01). No significant differences in myometrial stiffness were observed concerning age, BMI, previous pregnancies, uterine flexion and menstrual cycle phase. Transabdominal SWE of uterine stiffness seems to be a fast and practicable method in a clinical setting. Uterine stiffness appears to be largely independent of various factors, except for the mode of delivery. However, further studies are needed to validate these results.
Collapse
Affiliation(s)
- Judith M Stader
- Department of Nuclear Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Tolga Tonguc
- Department of Diagnostic and Interventional Radiology, Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Olga Ramig
- Department of Diagnostic and Interventional Radiology, Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Marcus Thudium
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Dieter Matlac
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Nikola Mutschler
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Eva K Egger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Jim Küppers
- Department of Nuclear Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jürgen Jenne
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | | | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| |
Collapse
|
2
|
Wang J, Qin W, Zhong Y, Hu H, Yang J, Huang H, Huang N, Liu S, Li J, Zheng L, Qin A, Lu Z. Injectable collagen hydrogel combines human umbilical cord mesenchymal stem cells to promote endometrial regeneration in rats with thin endometrium. Int J Biol Macromol 2024; 254:127591. [PMID: 37884246 DOI: 10.1016/j.ijbiomac.2023.127591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/10/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
The regeneration of thin endometrium still remains as a great challenge in the field of reproductive medicine. Stem cells-based therapy has been considered as a promising strategy for the restoration of thin endometrium. However, the low transplantation and retention rate of stem cells and loss of stemness due to in vitro expansion limits the therapeutic efficacy. In our study, we combined collagen hydrogel and human umbilical cord mesenchymal stem cells (uMSCs) for improving the regeneration of thin endometrium, by using the potent pluripotency and low immunogenicity of uMSCs and collagen hydrogel that promotes the anchorage and proliferation of stem cells. Results showed that collagen hydrogel has favorable biocompatibility and the capacity to enhance the cell viability and expression of stemness-associated genes (including organic cation/carnitine transporter4 (Oct-4), Nanog homeobox (Nanog) and SRY-box transcription factor 2 (SOX2)) of uMSCs. The combination of collagen hydrogel and uMSCs prolonged the retention time of the constructs in the uterine cavity and improved endometrial thickness compared with uMSCs alone, leading to increase the fertility of the rats with thin endometrium. These highlighted therapeutic prospects of collagen hydrogel combined with uMSCs for the minimally invasive therapy of thin endometrium in the clinic.
Collapse
Affiliation(s)
- Jiawei Wang
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Weili Qin
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yanping Zhong
- Institute of Life Science, Guangxi Medical University, Nanning 530021, China
| | - Hao Hu
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Junxu Yang
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Hanji Huang
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Institute of Life Science, Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Nanchang Huang
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Shuhan Liu
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jiaxu Li
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Li Zheng
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Institute of Life Science, Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China.
| | - Aiping Qin
- Center of Reproductive Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
| | - Zhenhui Lu
- Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Institute of Life Science, Guangxi Medical University, Nanning 530021, China; Guangxi Key Laboratory of Regenerative Medicine, The First Afliated Hospital of Guangxi Medical University, Nanning 530021, China.
| |
Collapse
|
3
|
Eboh S, Burghul S, Galloway M, Sanchez A, Ventolini G. Preterm Complete Uterine Rupture With En Caul Expulsion. Clin Med Insights Case Rep 2022; 15:11795476221112376. [PMID: 35845355 PMCID: PMC9280791 DOI: 10.1177/11795476221112376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022] Open
Abstract
Spontaneous uterine rupture is a catastrophic obstetric complication for both the mother and fetus. We highlight a case of a 32-year-old G2P1A0L1 Hispanic female at 36 weeks gestation who presented to the labor and delivery unit with minimal prenatal care, complaining of abdominal pains and vaginal bleeding. An abdominopelvic ultrasound confirmed an empty uterus and fetal demise in the abdominal cavity, leading to an exploratory laparotomy to evacuate the fetus. At surgery, a preterm sized fetus “en caul” with intact amnions was floating in the abdominal cavity and a hemostatic, complete rupture of the anterior uterine wall was discovered. Uterus was repaired and the patient recovered postoperatively without complications. Despite the best evidence suggesting that a history of low-transverse Cesarean section poses a low risk for spontaneous uterine rupture, this complication should always be considered and patients should be counseled regardless of the low risk should they desire a cesarean section.
Collapse
Affiliation(s)
- Stanley Eboh
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Suna Burghul
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Michael Galloway
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Asley Sanchez
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| |
Collapse
|
4
|
Jha N, Madhuri MS, Jha AK, Kubera NS. Subsequent Pregnancy Outcome in Women with Prior Complete Uterine Rupture: A Single Tertiary Care Centre Experience. Reprod Sci 2022; 29:1506-1512. [PMID: 35246823 DOI: 10.1007/s43032-022-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022]
Abstract
Limited data is available to assess the burden of maternal morbidity, mortality, and perinatal outcome after subsequent pregnancy in women with prior uterine rupture. Therefore, this retrospective descriptive study was conducted to determine subsequent pregnancy outcomes in a larger series of women with prior complete uterine rupture. All pregnant women who had complete uterine rupture were managed according to the standard Institute protocol. The women who conceived following a uterine repair from July 2011 to June 2020 were recruited into the study. Outcome measures included severe maternal morbidities and perinatal outcomes. Fifty-three women with prior complete uterine rupture were conceived subsequently. Two women had an abortion in the first and second trimester, respectively. None of the women developed recurrence of uterine rupture. However, three women developed uterine dehiscence in a total of 16 women who went into spontaneous labour before elective cesarean delivery at 32, 36, and 37 weeks, respectively. None of the women had placenta previa, placenta accreta, bowel injury, bladder injury and none required a hysterectomy. However, 16.7% of women needed a blood transfusion. None of the women required mechanical ventilation, inotropic support, and intensive care unit stay. Seventeen babies required neonatal intensive care admission, and prematurity (90%) was the most common reason, followed by low APGAR scores. In conclusion, subsequent pregnancy outcomes in women with prior uterine rupture appear acceptable in institutionalized care. Timing of cesarean delivery may have to be weighed against the risk of prematurity-associated neonatal morbidity and mortality.
Collapse
Affiliation(s)
- Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - M S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - N S Kubera
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| |
Collapse
|
5
|
Tao J, Mu Y, Chen P, Xie Y, Liang J, Zhu J. Pregnancy complications and risk of uterine rupture among women with singleton pregnancies in China. BMC Pregnancy Childbirth 2022; 22:131. [PMID: 35172764 PMCID: PMC8851699 DOI: 10.1186/s12884-022-04465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. METHODS We obtained all data from China's National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. RESULTS The risk of UR was increased 2.0-fold (1.2-fold to 2.7-fold) in women with pregnancy complications (except for preeclampsia). These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. The risk of UR was slightly higher in women with gestational diabetes mellitus who had a large for gestational age (LGA) foetus, especially at 32 to 36 weeks gestation. CONCLUSIONS The risk of UR is associated with gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta, but varies in different gestational ages.
Collapse
Affiliation(s)
- Jing Tao
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| |
Collapse
|
6
|
Jha N, Sagili H, Sharma J, Jha AK. A Rare Type of Uterine Rupture Following Over-the-Counter Use of Misoprostol in Second Trimester Abortion. Sultan Qaboos Univ Med J 2021; 21:657-659. [PMID: 34888091 PMCID: PMC8631213 DOI: 10.18295/squmj.4.2021.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/15/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
The use of misoprostol in the second trimester by a woman with a uterine scar may lead to severe contractions and uterine rupture. We report a 24-year-old pregnant female patient who presented at the Emergency Department at a tertiary care hospital in Puducherry, India, in 2020 with haemorrhagic shock. She was at 16 weeks of gestation and had taken over the counter misoprostol for inducing an abortion. A quick initial resuscitation and urgent laparotomy were performed. An irreparable circumferentially avulsed uterus suspended only by round ligaments was noted. Haemostasis required internal artery ligation and immediate total hysterectomy. The patient was doing well upon follow-up six months after the surgery. Proper and supervised use of misoprostol in the appropriate dosage can avoid life-threatening consequences of uterine rupture.
Collapse
Affiliation(s)
| | | | | | - Ajay K Jha
- Anesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
7
|
Lin J, Wang Z, Huang J, Tang S, Saiding Q, Zhu Q, Cui W. Microenvironment-Protected Exosome-Hydrogel for Facilitating Endometrial Regeneration, Fertility Restoration, and Live Birth of Offspring. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2007235. [PMID: 33590681 DOI: 10.1002/smll.202007235] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Thin endometrium is a primary cause of failed embryo transfer, resulting in long-term infertility and negative family outcomes. While hormonal treatments have greatly improved fertility results for some women, these responses remain unsatisfactory due to damage and infection of the complex endometrial microenvironment. In this study, a multifunctional microenvironment-protected exosome-hydrogel is designed for facilitating endometrial regeneration and fertility restoration via in situ microinjection and endometrial regeneration. This exosome hydrogel is formulated via Ag+ -S dynamic coordination and fusion with adipose stem cell-derived exosomes (ADSC-exo), yielding an injectable preparation that is sufficient to mitigate infection risk while also possessing the antigenic contents and paracrine signaling activity of the ADSC source cells, enabling regeneration of the endometrial microenvironment. In vitro, this exosome-hydrogel exerts an outstanding neovascularization-promoting effect, increased human umbilical vein endothelial cell proliferation and tube formation for 1.87 and 2.2 folds. In vivo, microenvironment-protected exosome-hydrogel also reveals to promote neovascularization and tissue regeneration while suppressing local tissue fibrosis. Importantly, regenerated endometrial tissue is more receptive to give embryos and birth to a healthy newborn. This microenvironment-protected exosome-hydrogel system offers a convenient, safe, and noninvasive approach for repairing thin endometrium and fertility restoration.
Collapse
Affiliation(s)
- Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, P. R. China
| | - Zhen Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, P. R. China
| | - Shengluan Tang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, P. R. China
| | - Qimanguli Saiding
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, P. R. China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| |
Collapse
|
8
|
Bitan R, Wainstock T, Landau D, Sheiner E, Pariente G. Uterine rupture and long-term cardiovascular hospitalization of the offspring. J Matern Fetal Neonatal Med 2020; 35:3276-3283. [PMID: 32933370 DOI: 10.1080/14767058.2020.1818204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Uterine rupture is associated with severely adverse maternal and neonatal outcomes. The association between uterine rupture and long-term cardiovascular hospitalization of the offspring has not been investigated yet. METHODS In a population-based cohort study, the incidence of cardiovascular related hospitalizations was compared between singletons born to mothers with and without uterine rupture in the current pregnancy. Cardiovascular hospitalization up to the age of 18 years was assessed according to a predefined set of ICD-9 codes associated with offspring hospitalization. Multiple gestations, perinatal deaths, lacking prenatal care, and children with congenital malformations or chromosomal abnormalities were excluded from the study. A Kaplan-Meier survival curve was used to assess cumulative incidence of cardiovascular hospitalization of the offspring. A Cox proportional hazards model was performed to control for confounders. RESULTS During the study period, 238,622 newborns met the inclusion criteria, of which 0.053% (n = 127) were born to mothers with uterine rupture in the current pregnancy. Children born to mothers with uterine rupture had significantly higher rates of cardiovascular related hospitalization (Kaplan-Meier's survival curve log-rank test, p=.005). CONCLUSION Being born following uterine rupture is an independent risk factor for long-term pediatric cardiovascular hospitalization. Highlights Uterine rupture is a risk factor for long-term pediatric cardiovascular related hospitalization. Rising rate of CS potentially associate to long-term offspring cardiovascular disease. Cardiovascular surveillance is needed for newborns delivered after uterine rupture.
Collapse
Affiliation(s)
- Roy Bitan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniela Landau
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
9
|
Chao AS, Chang YL, Yang LY, Chao A, Chang WY, Su SY, Wang CJ. Laparoscopic uterine surgery as a risk factor for uterine rupture during pregnancy. PLoS One 2018; 13:e0197307. [PMID: 29787604 PMCID: PMC5963787 DOI: 10.1371/journal.pone.0197307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
The incidence of uterine rupture through a previous cesarean scar (CS) is declining as a result of a lower parity and fewer options for vaginal birth after cesarean. However, uterine ruptures attributable to other causes that traumatize the myometrium are on the rise. To determine whether changes in the causes of uterine rupture had occurred in recent years, we retrospective retrieved the clinical records of all singletons with uterine rupture observed in the delivery room of a Taiwanese tertiary obstetric center over a 15-year period. The overall uterine rupture rate was 3.8 per 10,000 deliveries. A total of 22 cases in 20 women (with two of them experiencing two episodes). Seven uterine ruptures occurred through a previous cesarean scar (CS ruptures, 32%), 13 through a non-cesarean scar (non-CS ruptures, 59%), whereas the remaining two (9%) were in women who did not previously undergo any surgery. All of the 13 non-CS ruptures were identified in women with a history of laparoscopic procedures to the uterus. Specifically, 10 (76%) occurred after a previous laparoscopic myomectomy, one (8%) following a hysteroscopic myomectomy, and two (16%) after a laparoscopic wedge resection of cornual ectopic pregnancy. Severe bleeding (blood loss >1500 mL) requiring transfusions was more frequent in women who experienced non-CS compared with CS ruptures (10 versus 1 case, respectively, P = 0.024). Patients with a history of endoscopic uterine surgery should be aware of uterine rupture during pregnancy.
Collapse
Affiliation(s)
- An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail: (CJW); (ASC)
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Angel Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Yang Chang
- Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Yuan Su
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
- * E-mail: (CJW); (ASC)
| |
Collapse
|
10
|
AlSaad D, Alobaidly S, Abdulrouf P, Thomas B, Ahmed A, AlHail M. Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review. Ther Clin Risk Manag 2017; 13:625-627. [PMID: 28533686 PMCID: PMC5431700 DOI: 10.2147/tcrm.s132294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. Case presentation We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. Conclusion We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results.
Collapse
Affiliation(s)
- Doua AlSaad
- Department of Pharmacy, Women's Hospital, Hamad Medical Corporation, Doha, Qatar.,Public Health Program, London School of Hygiene and Tropical Medicine, University of London, UK
| | | | - Palli Abdulrouf
- Department of Pharmacy, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Binny Thomas
- Clinical Support Service Unit, Hamad Medical Corporation, Doha, Qatar.,Pharmacy and Life Sciences Research Institute, Robert Gordon University, Aberdeen, Scotland
| | - Afif Ahmed
- Department of Pharmacy, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Moza AlHail
- Department of Pharmacy, Women's Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
11
|
Sturzenegger K, Schäffer L, Zimmermann R, Haslinger C. Risk factors of uterine rupture with a special interest to uterine fundal pressure. J Perinat Med 2017; 45:309-313. [PMID: 27235667 DOI: 10.1515/jpm-2016-0023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/19/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Uterine rupture is a rare but serious event with a median incidence of 0.09%. Previous uterine surgery is the most common risk factor. The aim of our study was to analyze retrospectively women with uterine rupture during labor and to evaluate postulated risk factors such as uterine fundal pressure (UFP). METHODS Twenty thousand one hundred and fifty-two deliveries were analyzed retrospectively. Inclusion criteria were 22 weeks and 0 days-42 weeks and 0 days of gestation, singleton pregnancy and cephalic presentation. Women with primary cesarean section were excluded. A logistic regression analysis adjusting for possible risk factors was conducted and a subgroup analysis of women with unscarred uterus was performed. RESULTS Twenty-eight cases of uterine rupture were identified (incidence: 0.14%). Uterine rupture was noticed in multipara patients only. In the multivariate analysis among all study patients, only previous cesarean section remained a statistically significant risk factor [adjusted odds ration (adj. OR) 12.52 confidence interval (CI) 95% 5.21-30.09]. In the subgroup analysis among women with unscarred uterus (n=19,415) three risk factors were associated with uterine rupture: UFP (adj. OR 5.22 CI 95% 1.07-25.55), abnormal placentation (adj. OR 20.82 CI 95% 2.48-175.16) and age at delivery >40 years (adj. OR 4.77 CI 95% 1.44-15.85). CONCLUSIONS The main risk factor for uterine rupture in the whole study population is previous uterine surgery. Risk factors in women with unscarred uterus were UFP, abnormal placentation, and age at delivery >40 years. The only factor which can be modified is UFP. We suggest that UFP should be used with caution at least in presence of other supposed risk factors.
Collapse
Affiliation(s)
- Karin Sturzenegger
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| | - Leonhard Schäffer
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| | - Christian Haslinger
- Division of Obstetrics, University Hospital of Zürich, Frauenklinikstrasse 10, 8091 Zürich
| |
Collapse
|
12
|
Langhe R, Shah UF, Alfathil A, Gannon M. Silent uterine rupture in scarred uterus. BMJ Case Rep 2017; 2017:bcr-2016-218189. [PMID: 28343154 DOI: 10.1136/bcr-2016-218189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Uterine rupture in pregnancy is a rare and catastrophic complication with a high incidence of fetal and maternal morbidity. Very few cases have been reported in the literature. CASE PRESENTATION A 28-year-old fifth gravid woman with a history of one caesarean section presented to our department at 39 weeks and 6 days gestation with complaints of headache, epigastric pain and nausea. Her blood pressure was elevated and there was proteinuria. Emergency caesarean section was performed in view of symptoms. Uterine rupture was found during the surgery. A live male infant was delivered in good condition. Postnatal recovery was unremarkable and the woman discharged on postoperative day 5. CONCLUSION Rupture of the uterus can present in third trimester even before labour with minimal or no symptoms.
Collapse
Affiliation(s)
- Ream Langhe
- Obstetrics and Gynaecology, Midland Regional Hospital Mullingar, Mullingar, Ireland
| | - Umme Farwa Shah
- Obstetrics and Gynaecology, Midland Regional Hospital Mullingar, Mullingar, Ireland
| | - Attia Alfathil
- Obstetrics and Gynaecology, Midland Regional Hospital Mullingar, Mullingar, Ireland
| | - Michael Gannon
- Obstetrics and Gynaecology, Midland Regional Hospital Mullingar, Mullingar, Ireland
| |
Collapse
|
13
|
Sayed Ahmed WA, Habash YH, Hamdy MA, Ghoneim HM. Rupture of the pregnant uterus – a 20-year review. J Matern Fetal Neonatal Med 2016; 30:1488-1493. [DOI: 10.1080/14767058.2016.1219997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
14
|
Eshkoli T, Weintraub AY, Baron J, Sheiner E. The significance of a uterine rupture in subsequent births. Arch Gynecol Obstet 2015; 292:799-803. [DOI: 10.1007/s00404-015-3715-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
|
15
|
Dinglas C, Rafael TJ, Vintzileos A. Is manual palpation of the uterine scar following vaginal birth after cesarean section (VBAC) helpful? J Matern Fetal Neonatal Med 2014; 28:839-41. [PMID: 24939626 DOI: 10.3109/14767058.2014.935326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Risk of uterine rupture with trial of labor after cesarean (TOLAC) is less than one percent. Discovery of uterine rupture often occurs during labor. In our case, the uterine scar is discovered to be ruptured during the postpartum period. The exact cause and time of uterine rupture is difficult to ascertain in this case, yet manual palpation of the uterine scar did not aid in the eventual diagnosis.
Collapse
Affiliation(s)
- C Dinglas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Winthrop University Hospital , Mineola, NY , USA
| | | | | |
Collapse
|
16
|
|
17
|
|
18
|
Sun HD, Su WH, Chang WH, Wen L, Huang BS, Wang PH. Rupture of a pregnant unscarred uterus in an early secondary trimester: a case report and brief review. J Obstet Gynaecol Res 2012; 38:442-5. [PMID: 22229814 DOI: 10.1111/j.1447-0756.2011.01723.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.
Collapse
Affiliation(s)
- Hsu-Dong Sun
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Ban Ciao, New Taipei City, Taiwan
| | | | | | | | | | | |
Collapse
|
19
|
Humm KR, Adamantos SE, Benigni L, Armitage-Chan EA, Brockman DJ, Chan DL. Uterine Rupture and Septic Peritonitis Following Dystocia and Assisted Delivery in a Great Dane Bitch. J Am Anim Hosp Assoc 2010; 46:353-7. [DOI: 10.5326/0460353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A Great Dane bitch was treated for presumed primary uterine inertia with repeated doses of oxytocin and manually assisted whelping. She was diagnosed with uterine rupture and septic peritonitis the following day. The uterine rupture is hypothesized to have occurred as a result of the management strategy used to treat dystocia. The dog underwent ovariohysterectomy, and the septic peritonitis was managed with open peritoneal drainage. The dog recovered well and was discharged 5 days later. No previous reports of canine uterine rupture associated with manual intervention appear to have been published. This report highlights the potential dangers involved in such an approach.
Collapse
Affiliation(s)
- Karen R. Humm
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA United Kingdom
- From the
| | - Sophie E. Adamantos
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA United Kingdom
- From the
| | - Livia Benigni
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA United Kingdom
- From the
| | - Elizabeth A. Armitage-Chan
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA United Kingdom
- From the
| | - Daniel J. Brockman
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA United Kingdom
- From the
| | - Daniel L. Chan
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA United Kingdom
- From the
| |
Collapse
|
20
|
Lee NK, Kim S, Lee JW, Sol YL, Kim CW, Hyun Sung K, Jang HJ, Suh DS. Postpartum hemorrhage: Clinical and radiologic aspects. Eur J Radiol 2010; 74:50-9. [DOI: 10.1016/j.ejrad.2009.04.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 04/23/2009] [Indexed: 11/25/2022]
|
21
|
Al-Zirqi I, Stray-Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG 2010; 117:809-20. [DOI: 10.1111/j.1471-0528.2010.02533.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
22
|
|
23
|
Sahin HG, Kolusari A, Yildizhan R, Kurdoglu M, Adali E, Kamaci M. Uterine rupture: A twelve-year clinical analysis. J Matern Fetal Neonatal Med 2009; 21:503-6. [DOI: 10.1080/14767050802042225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
24
|
Abstract
Uterine rupture, uterine inversion, and pelvic lacerations/hematomas are all associated with increased risk for hemorrhage at the time of delivery. Certain clinical factors will increase the likelihood that these complications will occur, and clinical management can be adapted to reduce risk. Prior cesarean section is a significant risk factor for uterine rupture, with the degree of risk directly related to the location and quantity of prior uterine incisions. Obstetric trauma is another independent risk factor for uterine rupture. In turn, uterine inversion has traditionally been associated with overly aggressive management of the third stage of labor. The forces of normal labor and delivery will sometimes result in lacerations and hematomas of the lower genital tract. Except for the most superficial tears, these lacerations require surgical repair to restore proper anatomical appearance and support and to limit blood loss. Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality.
Collapse
Affiliation(s)
- Fadi G Mirza
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, Medical Center, New York, NY 10032, USA.
| | | |
Collapse
|
25
|
Kaczmarczyk M, Sparén P, Terry P, Cnattingius S. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG 2007; 114:1208-14. [PMID: 17877673 DOI: 10.1111/j.1471-0528.2007.01484.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Uterine rupture is a rare but a catastrophic event. The aim of the present study was to explore the risk factors for uterine rupture and associated neonatal morbidity and mortality among a cohort of Swedish women attempting vaginal birth in their second delivery. DESIGN Population-based cohort study. SETTING Sweden. POPULATION A total of 300,200 Swedish women delivering two single consecutive births between 1983 and 2001. METHODS Swedish population-based registers were used to obtain information concerning demographics, pregnancy and birth characteristics, and neonatal outcomes. Logistic regression was used to analyse potential risk factors for uterine rupture and risk of neonatal mortality associated with uterine rupture. Odds ratios were used to estimate relative risks using 95% CI. MAIN OUTCOME MEASURE Uterine rupture and neonatal mortality in the second pregnancy. RESULTS Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73-57.00). Induction of labour, high (> or = 4000 g) birthweight, postterm (> or = 42 weeks) births, high (> or = 35 years) maternal age, and short (< or = 164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60-132.08). CONCLUSION The risk of uterine rupture in subsequent deliveries is not only markedly increased among women with a previous caesarean delivery but also influenced by induction of labour, birthweight, gestational age, and maternal characteristics.
Collapse
Affiliation(s)
- M Kaczmarczyk
- Department of Epidemiology, Emory University, School of Public Health, Atlanta, GA 30307, USA.
| | | | | | | |
Collapse
|
26
|
Menias CO, Elsayes KM, Peterson CM, Huete A, Gratz BI, Bhalla S. CT of pregnancy-related complications. Emerg Radiol 2007; 13:299-306. [PMID: 17216173 DOI: 10.1007/s10140-006-0570-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
During pregnancy, the risk of radiation exposure to the fetus is increased so that more than the usual benefit is necessary to justify computed tomography (CT; or other radiation exposure) than in non-pregnant patients. In the setting of a life-threatening illness, CT may be indicated to assess for potentially fatal complications such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. After delivery, patients rarely develop serious problems requiring radiologic evaluation. When indicated, however, CT may be invaluable in making the diagnosis or determining the severity of peri- and post-partum complications, including uterine perforation, hemorrhage, endometritis, thrombophlebitis, and abscess formation. At times, CT may be the first to uncover conditions, such as post-partum cardiomyopathy, and heart failure, which are usually diagnosed by other modalities but may explain the symptoms for which the study was ordered. In some centers, CT pulmonary angiography represents the standard of care to diagnose pulmonary thromboembolism. In this article, we illustrate the spectrum of peri-partum and post-partum complications on CT to familiarize the radiologist with the CT features of these potentially life-threatening pregnancy-related complications.
Collapse
Affiliation(s)
- Christine O Menias
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
| | | | | | | | | | | |
Collapse
|