Blood supply to the uterus and ovaries in healthy women and patients with ovarian insufficiency

The aim of this study was to investigate the relation between ovarian blood flow, folliculogenesis and sex-steroid production during normal menstrual cycle and in women with ovarian failure. Ten healthy women and 40 patients with ovarian failure underwent hormonal assays (follicle-stimulating, luteinizing hormones, estradiol, progesterone, prolactine, testosterone) and ultrasound examination of the uterus and ovaries with color Doppler ultrasonography of the uterine and ovarian vessels on the 3 -5th, 11- 13th, 17- 19th and 21 -23rd days оf menstrual cycle. Intraovarian blood flow of the ovary carrying the predominant follicle in healthy women appeared more active than in conrdlateral ovary on the 3-5th days of the cycle. Inpatients with ovarian failure no difference was detected between the ovaries during the periods in question. Ovarian and uterine blood flow inpatients with the ovarian failure was less intensive comparingwith healthy women. Positive correlation between uterine blood flow and estradiol concentration in serum was revealed.

Diagnostic role of uterine artery dopplerometry in the first trimester of pregnancy

A Doppler sonographic examination of blood flow in the left and right uterine arteries was carried out in women in the first trimester of pregnancy. Systolic- diastolic ratio (S/D) andpulsative index (PI) were assessed in 71 women with physiological course of pregnancy and in 49 women with threatened abortion. The investigation revealed clear connection of the uterine blood flow lateralization and corpus luteum localization. These interrelations are characterized differently in case of physiological pregnancy and threatened abortion. The new approach to the evaluation of uterine blood flow gives an ability ofpreclinical diagnostics of threatened abortion.

Ovarian and uterine two-dimensional and Doppler ultrasonographic changes in the feline peri-estrus period

Objectives The aim of this study was to evaluate two-dimensional and Doppler ultrasonographic changes of the ovary and uterus during estrus and the early post-estrus period in domestic cats. Methods Two-dimensional and Doppler ultrasonographic evaluations of the ovaries and uterus were performed in seven queens on days 1, 3 and 5 of estrus, and 5 days after estrus (AE5). Results On day 1, 5.4 ± 0.5 follicles of 2.1 ± 0.1 mm were detected progressively increasing in number and size up to day 5 and then decreased on AE5 ( P <0.05). A maximum follicular diameter of 4.1 ± 0.1 mm was achieved on day 5. Both during and after estrus, the uterus was generally hypoechoic compared with the surrounding tissues and delineated by a thin hyperechoic line corresponding to the serosa. In some animals, the uterine layers were distinguished during and after estrus. The blood flow waveforms of the intraovarian and uterine arteries were characterized by a systolic peak and diastolic flow extending throughout the remainder of the cardiac cycle to the next systole. In the uterine artery waveforms, the early diastolic notch was mild or absent during most estrous observations. The resistance index of the intraovarian arteries decreased up to day 5, and then increased on AE5 ( P <0.05). The resistance index of the uterine arteries was lower during estrus than in the post-estrus period ( P <0.05). Conclusions and relevance It is concluded that in the domestic cat, follicular number and diameter as well as ovarian and uterine blood flow changed during and immediately after estrus. Doppler ultrasound proved suitable to evaluate the hemodynamic changes involved in the cyclic remodeling of ovarian and uterine tissues that occurs during and after follicular growth in domestic cats.

Primary Dysmenorrhea: pathophysiology

The present study was conducted to investigate and analyze the recent and relevant studies about primary dysmenorrhea and its pathophysiology. Literature searches were performed electronically in PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, Google Scholar and the Cochrane Library for original articles written in English and in Scielo, Lantidex, Imbiomed-L, Redalyc and Google Scholar for original articles written in Spanish. The searches included the key words (Mesh): menstruation, menstrual period, menstrual cycle, dysmenorrhea, primary dysmenorrhea, inflammatory substance and inflammatory markers. Publications from January 1980 to February 2021 were reviewed. Dysmenorrhea is the most common gynecologic condition experienced by menstruating women. It is characterized by crampy lower abdominal pain that can range widely in severity, and associated to others symptoms. Its overall impact often has significant medical and psychosocial implications. The hallmark of primary dysmenorrhea is painful menses in the absence of any associated macroscopic pathologic process, and it occurs in up to 50% of menstruating females and causes significant disruption in quality of life and absenteeism. An excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation have been mentioned as the main cause of primary dysmenorrhea. The uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure. Uterine hypercontractility, reduced uterine blood flow and increased peripheral nerve hypersensitivity induce pain. Diagnosis rests on a good history with negative pelvic evaluation findings. This narrative review investigated and analyzed the pathophysiology of primary dysmenorrhea and the implications of other chemical substances.

CORRELATION OF CYCLICAL CHANGES IN ENDOMETRIUM AND UTERINE BLOOD FLOW WITH OVULATION, AND TO PREDICT THE APPROXIMATE TIME OF OVULATION

Background & Method: The study was carried out in the Department of Radio diagnosis, Index Medical College, Hospital & Research Centre, Indore with an aim to correlate of cyclical changes in endometrium and uterine blood flow with ovulation, and to predict the approximate time of ovulation. Result: The study shows maximum numbers of cases (78%) have endometrial thickness more than 7 mm and most of them belongs to fertile group, while 22% cases have endometrial thickness less than 7mm and they all belong to infertile group. The study shows 66% of cases have 5 layered endometrial appearance and almost all of them were fertile and 34% cases have hazy 5 layered or no layering and most of them (14 out of 17) belongs to infertile group. In this study 68% patients have multifocal endometrial blood supply and almost all of them are fertile while 32% patients have absent or sparse endometrial blood flow. Conclusion: The advent of color flow imaging has enabled the detection of neovascularization and change in blood flow in endometrium and myometrium. In the study it was noted that 5 layered endometrium was present in almost all fertile cases while in infertile cases endometrium was single layer or hazy 5 layered, so it can be postulated that distinct 5 layered endometrium is associated with fruitful pregnancy outcome. It was also noted frequently in the study that endometrium thickness less than 7mm was commonly seen in infertile cases while patients having more than 7mm thick endometrium were from fertile group, so it can be postulated that good endometrial thickness provides more chances for fruitful pregnancy outcome. Keywords: Endometrium, Uterine & Ovulation.

246 Examining Melatonin-induced Changes in Uterine Blood Flow and Vaginal Temperatures in Nutrient Restricted Pregnant Heifers

The objectives were to examine melatonin mediated changes in temporal uterine blood flow (UBF) and vaginal temperatures (VT) in 54 Brangus heifers (Fall, n = 29; Summer, n = 25) during compromised pregnancy. At d160 of gestation, heifers were assigned to 1 of 4 groups consisting of adequately fed (ADQ-CON; 100% NRC; n=13), global nutrient restricted (RES-CON; 60% NRC; n = 13), and ADQ or RES supplemented with 20 mg of melatonin (ADQ-MEL, n = 13; RES-MEL, n = 15). In the morning (0500h) and afternoon (1300h) of d220 of gestation, temperature dataloggers (Onset Computer Corporation) attached to progesterone-free CIDRs were used to record VT, while UBF was determined via Doppler ultrasonography. Data were analyzed using repeated measures of ANOVA (SAS). Significant differences were found in UBF and VT between Fall and Summer groups (P&lt; 0.05), therefore seasons were individually analyzed. In Fall, a nutrition by treatment interaction was significant, where the RES-CON heifers exhibited reduced total UBF compared to ADQ-CON (5.67±0.68 vs. 7.97±0.54 L/min; P = 0.012). In Summer, there was not a main effect of nutrition (P = 0.390); nevertheless, the MEL heifers exhibited increased total UBF compared to the CON counterparts (8.16±0.73 vs. 6.00±0.70 L/min; P = 0.048). Moreover, there was a nutrition by treatment by time interaction in VT for Fall and Summer heifers (P &lt; 0.0001). In Fall, all groups had decreased VT in the morning compared to the afternoon (P &lt; 0.0001). Whereas, in Summer, VT increased for ADQ-CON, RES-CON, and ADQ-MEL from morning to afternoon (P &lt; 0.0001), while the RES-MEL remained constant throughout the day (P = 0.649). Furthermore, during the afternoon RES-MEL heifers exhibited decreased VT compared to ADQ-CON (38.91±0.09 vs. 39.26±0.09°C, respectively; P=0.039). In summary, nutrient restriction and melatonin supplementation altered UBF in a season dependent manner. Additionally, with the VT differences observed in Summer, future studies should evaluate the potential of melatonin supplementation for mitigating heat stress in farm animals.

249 Effects of Maternal Nutrient Restriction During Late Gestation on Uterine Blood Flow and Placental Size in the Primiparous Bovine Dam

To determine effects of late gestational maternal nutrient restriction (NR) on uteroplacental blood flow and placental growth, primiparous fall-calving crossbred beef heifers [BW: 451 ± 28 (SD) kg; BCS: 5.4 ± 0.7] were individually-fed either 100% (control; CON; n = 12) or 70% (n = 13) of energy and protein requirements for maintenance, pregnancy, and growth during the last 120 days of gestation. Transrectal color Doppler ultrasonography of both uterine arteries was conducted pre-treatment and every 21 d during treatments. Placentas were split into ipsilateral and contralateral sides, dissected (cotyledonary vs. intercotyledonary), and dried. Data were analyzed with treatment, treatment initiation date, and calf sex (when P &lt; 0.25) as fixed effects. Uterine blood flow included day and treatment x day (repeated measures). Dam BW was less (P ≤ 0.01) from d 223 of gestation through parturition for NR dams, but calf BW was not affected (P = 0.72) by treatment. The interaction affected (P &lt; 0.01) heart rate, where NR dams had decreased heart rate after treatments began. Treatment did not affect (P ≥ 0.20) uterine artery blood flow or hemodynamics, but all variables were affected (P ≤ 0.04) by day. Contralateral total and cotyledonary weights tended (P ≤ 0.09) to be greater and ipsilateral and total cotyledonary:intercotyledonary ratios were greater (P ≤ 0.01) for CON. Cotyledon number, cotyledon size, and total cotyledonary, intercotyledonary, and placental weight were not affected (P ≥ 0.15) by treatment. Relative to dam BW, uterine blood flow was not affected (P = 0.83), but relative placental weight tended to be greater (P = 0.09) in NR dams. In the current study, NR dams lost maternal BW during late gestation and had less contralateral placental growth, yet uterine blood flow was maintained and placental size relative to BW ensured fetal growth similar to CON offspring.

Maternal B cell signaling orchestrates fetal development in mice

B cell participation in early embryo/fetal development and the underlying molecular pathways have not been explored. To understand whether maternal B cell absence or impaired signaling interferes with placental and fetal growth, we paired CD19-deficient (CD19−/-) mice, females with B cell-specific MyD88 (BMyD88−/-) or IL-10 (BIL-10−/-) deficiency as well as WT and MyD88−/- controls on C57Bl/6 background with BALB/c males. Pregnancies were followed by ultrasound and Doppler measurements. Implantation number was reduced in BMyD88−/- and MyD88−/- mice. Loss of MyD88 or B cell-specific deletion of MyD88 or IL-10 resulted in decreased implantation areas at gestation days (gd)5, 8 and 10, accompanied by reduced placental thickness, diameter and areas at gd10. Uterine artery resistance was enhanced in BIL-10−/- dams at gd10. Challenge with 0.4mg LPS/kg BW at gd16 revealed that BMyD88−/-, BIL-10−/- and CD19−/- mothers delivered preterm while controls maintained their pregnancy. B cell specific MyD88 and IL-10 expression is essential for appropriate in utero development. IL-10+B cells are involved in uterine blood flow regulation during pregnancy. Finally, B cell-specific CD19, MyD88 and IL-10 expression influences susceptibility towards preterm birth.

Effectiveness of the Intrauterine Compression Balloon in Postpartum Hemorrhage, Riobamba Provincial Teaching Hospital – October 2015 to September 2016

Introduction: Postpartum hemorrhage is blood loss greater than 500 mL after a normal delivery or more than 1000 mL after a cesarean section, or any postpartum bleeding regardless of the amount causing hemodynamic instability. The uterine blood flow in a term pregnancy is approximately 500 to 700 mL/min, for this reason, a patient who presents this complication, in a few minutes, can be drained and compromise her life. Objective: To determine the efficacy of the intrauterine compression, balloon in the management of postpartum hemorrhage due to hypotonia or uterine atony, at the General Teaching Provincial Hospital of Riobamba from October 2015 to September 2016. Methodology: The effectiveness of the use of the intrauterine compression balloon after the failure of pharmacological management was analyzed and statistical evaluation was applied to determine the efficacy of this method for the management of this pathology. Results: It was placed in 23 patients who presented postpartum hemorrhage due to hypotonia or uterine atony, and it had an effectiveness of 94.4% after a vaginal delivery and 80% after a cesarean section. Reaffirming that it is an excellent option in the management of this type of complications. Conclusions: Postpartum hemorrhage is the second cause of maternal death nationwide, technical and timely action will help reduce maternal morbidity and mortality that this pathology can present; the use of the intrauterine hydrostatic compression balloon is an excellent alternative prior to the surgical management of this pathology. Keywords: postpartum hemorrhage, uterine bleeding, uterine tamponade with balloon. RESUMEN Introducción: La hemorragia posparto es la pérdida sanguínea mayor de 500 mL luego de un parto normal o más de 1000 mL luego de una cesárea, o cualquier sangrado posparto independientemente de la cantidad que cause inestabilidad hemodinámica. El riego sanguíneo uterino en un embarazo a término es de aproximadamente 500 a 700 mL/min por tal motivo, una paciente que presente esta complicación, en pocos minutos puede quedar exangüe y comprometer si vida. Objetivo: Determinar la eficacia del balón de compresión intrauterino en el manejo de la hemorragia posparto por hipotonía o atonía uterina, en el Hospital Provincial General Docente de Riobamba de Octubre del 2015 a septiembre del 2016. Metodología: Se analizó la efectividad del uso del balón de compresión intrauterina luego del fracaso del manejo farmacológico y se aplicó la evaluación estadística para determinar la eficacia de este método para el manejo de esta patología. Resultados: Se colocó en 23 pacientes que presentaron hemorragia posparto por hipotonía o atonía uterina, y se tuvo una efectividad del 94.4 por ciento luego de un parto vaginal y del 80% luego de una cesárea. Reafirmando que es una excelente opción en el manejo de este tipo de complicaciones. Conclusiones: La hemorragia posparto es la segunda causa de muerte materna a nivel nacional, el accionar técnico y oportuno ayudará a disminuir la morbimortalidad materna que puede presentar esta patología; la utilización del balón de compresión hidrostático intrauterino es una excelente alternativa previo al manejo quirúrgico de esta patología. Palabras clave: hemorragia posparto, hemorragia uterina, taponamiento uterino con balón.

Ovarian dynamics, hormone profiles, and characterization of ovarian and uterine blood flow in cycling Sahiwal cows

The objectives were to investigate the ovarian dynamics and hormonal profiles during the oestrus cycle, and to characterize the ovarian and uterine blood flow (OBF versus UBF) indices on the extent of vascular perfusion towards the dominant follicle (DF) or corpus luteum (CL) during the peri-ovulatory follicular wave in Sahiwal cows. In experiment 1, cyclic cows (n = 21) were selected at their spontaneous oestrus (day 0) and subjected to B-mode ultrasonography throughout the oestrus cycle. In experiment 2, cyclic cows (n = 9) were randomly selected at day 0, and categorized according to the intra-ovarian patterns as ovaries with DF (n = 3), CL (n = 3) or both (DF+CL; n = 3) to characterize the OBF and UBF indices using Doppler ultrasonography. The length of the oestrus cycle (days), number of follicular waves (n) and size (mm) of DF and CL were 20.1 ± 0.9, 2.1 ± 0.2, 14.7 ± 0.7 and 15.9 ± 2.5, respectively. The concentrations (ng/mL) of plasma progesterone increased linearly, and a peak was attained at day 12.2 ± 1.0. However, it reduced linearly with the onset of luteolysis at day 16.4 ± 0.3 of the oestrus cycle. The plasma progesterone (P4) concentrations and the diameter of CL correlated throughout the oestrus cycle. The mean OBF and UBF indices did not differ between intraovarian patterns. Taken together, this information on reproductive physiological parameters could be used to develop synchronization protocols to improve reproductive management in Sahiwal cows.