Shaamash AH, Ahmed AGM, Abdel Latef MM, Abdullah SA. Routine postpartum ultrasonography in the prediction of puerperal uterine complications.
Int J Gynaecol Obstet 2007;
98:93-9. [PMID:
17583710 DOI:
10.1016/j.ijgo.2007.03.042]
[Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/08/2007] [Accepted: 03/21/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES
To determine whether there is a relationship between the findings of routine postpartum ultrasonographic scanning and puerperal uterine complications such as heavy delayed postpartum hemorrhage, retained products of conception, and need for uterine curettage; and to estimate the value of both routine ultrasonographic scanning and clinical data in the prediction of these complications.
METHODS
In this cohort study 265 women were examined ultrasonographically on postpartum Days 1, 14, 42 following uncomplicated vaginal or cesarean deliveries. They were divided into a low-risk (n=149) and a high-risk (n=116) group according to predefined risk factors for puerperal uterine complications. The ultrasonographic findings were dichotomized into no masses (endometrial strip, endometrial fluid, or hyperechoic foci) or a definite intrauterine echogenic/heterogeneous mass (IUM, >15 mm in diameter).
RESULTS
The presence of risk factor(s) was significantly associated with uterine subinvolution, IUM, heavy delayed postpartum hemorrhage (PPH), and a need for uterine curettage. Multivariable logistic regression analysis for the risk factor(s) that can predict the occurrence of heavy delayed PPH showed that the presence of an IUM was the most predictive variable. The presence of an IUM and heavy delayed PPH predicted uterine curettage in 61.3% and 37.5% of patients, respectively.
CONCLUSION
Routine uterine scanning on Day 1 and Day 14 postpartum is an easy, inexpensive, valuable method that can be offered to women at high risk for delayed PPH due to subinvolution or the presence of an IUM. Accordingly, it may be predicted which women will benefit from uterine curettage in up to two-thirds of cases.
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