Postpartum Uterine Ultrasonographic Scale: a novel method to standardize the assessment of uterine postpartum involution

Postpartum hemorrhage is a leading cause of maternal mortality. Various methods can be used to evaluate the postpartum uterine cavity volume. This work aims to introduce a simple method for uterine postpartum cavity volume evaluation, called Postpartum Uterine Ultrasonographic Scale (PUUS), which could be used routinely. In this prospective study, 131 consecutive Caucasian patients were evaluated by using the PUUS method. The mean age was 27.72 years (ranging from 15 to 42). Patients were examined in the same time intervals: within the first 24-48 hours after delivery in case of vaginal delivery, and within the first 48-72 hours, in case of cesarean delivery. Patients with PUUS grades 2, 3, or 4 were reexamined daily until the PUUS grade declined to 1 or 0. The PUUS method evaluated the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). The PUUS grade of uterine involution varied with the day of examination, gestation, and parity. In this article, a novel method of evaluating uterine postpartum involution titled PUUS is introduced. This method standardized uterine cavity involution in a numerical fashion. We hope that the PUUS scale could further be used to decrease the morbidity and mortality of women due to postpartum hemorrhage.

The Role of Neurogenic Bioamines in Nerve Fibers of Uterus during the Postpartum Involution in Experimental Animal Models

Background: Biogenic amines (BAs) secreted by the sympathetic neural apparatus of rat uterus is reported to be conducive to the uterine functional activity during postpartum involution; the imbalance in BAs ratio could confer postpartum reproductive disorders including improper postpartum involution. Objective: The changes in density of uterine sympathetic nerves implicated in the pathology of endometriosis, adenomyosis, and delayed uterine involution. The present study is aimed to ascertain ‘serotonin’ and ‘catecholamine’ concentrations in mesenteric mast cells (MCs), and structural elements of nerve fibers across the perivascular plexuses (PPs) and single sympathetic nerve terminals (SST). Methods: Furthermore, the density of their spatial distribution (SDP and SDT) in the uterine body, cervix, and mesometrium was determined during postpartum involution. Tissue specimens of postpartum uterus were obtained from 55 nulliparous female Wistar outbred strain rats, which were grouped according to the days after parturition at the time of sacrifice. The nerve fibers of PP and SST exhibited emerald green fluorescence, which was detected by glyoxylic acid fluorescence technique; the fluorescence invoked by BAs was identified by microspectrofluorimetry. Results: Concentrations of BAs were extensive in the varicosities of PP and SST on the 10th day. However, the highest BA concentrations were found in structural elements of PP in the uterine mesometrium in the initial days of postpartum. In mesenteric MC, serotonin and catecholamines were at the highest concentration on 10th day postpartum. Histamines peaked on the 6th day. Conclusion: SDP and SDT were increased significantly in all structural elements of uterine nerve fibers in the uterine body and cervix compared to SDP in mesentery. Considering that catecholamines and serotonin are antagonists in many aspects of their biological action, the ratio of BAs should be well-balanced to maintain anabolic-catabolic equilibrium in the rat uterus.

Optimization methods for correcting the duration of the anovulatory period of cattle

Post-calving anestrus leads to serious economic losses and is the reason for the animal culling. Deficiency of estrogen and hypofunctional state of the ovaries due to negative energy balance, as well as violations of the timing of postpartum involution of the uterus are considered the leading causes of an extended anovulatory period in fresh cows. A comparison was made of the therapeutic efficacy of Ovsynch scheme and Ovariovit preparation when used in first heifers with post-calving anestrus against the background of ovarian hypofunction. When using Ovsynch scheme, the fertility of the first insemination was 50%; estrous cyclicity recovered in 80% of first heifers. When using Ovariovit, the fertility of the first insemination was 60%; the estrous cycle was restored in 100% of first heifers.

Hydrastinine with uterine bleeding.

Analyzing the pharmaceutical treatment of uterine bleeding, the author quite rightly stops at ergot preparations and hydrastis canadensis, as the most effective means. Ergot acts mainly on the very muscle of the uterus and, therefore, is shown in atonic bleeding, depending for example. from insufficient postpartum involution of the uterus, while hydrastis is most useful for so-called secondary bleeding that occurs under the influence of diseases of the uterine appendages, with chronic endometritis, in the menopausal period, in girls, etc. The disadvantage of this remedy, in the form of a liquid extract, is that it does not work well when used when bleeding has already occurred, and that to get the proper effect, it must be taken long (two weeks) before the expected Meno-or metrorrhagia.

Послеродовая инволюция миометрия мышей в условиях острого токсического гепатоза

The goal of the research was to study the structural processes of postpartum myometrial involution of C57Bl/6 mice in conditions of acute CCl4-induced hepatosis. The study was conducted on 60 female C57Bl/6 mice. Animals were divided into 2 groups: 1st – mice of the control group with physiological pregnancy, 2nd – pregnant mice with acute CCl4-induced hepatosis. The main mechanism of the process of postpartum involution of the myometrium of C57Bl/6 mice was clasmacytosis, that was morphologically represented by the presence of cytoplasmic conglomerates in the interstitium, and to a lesser extent myocyte apoptosis. More pronounced manifestations of the processes of involution were observed in the subserous muscle layer, smaller changes were observed in the vascular muscle layer and least of all in the subvascular (submucous) muscle layer. The myometrial involution processes in C57Bl/6 mice under conditions of acute CCl4-induced hepatosis slow down and do not end by the 10th day of the postpartum period, in contrast to mice of the control group.

Ultrasonic control over the course of the postnatal period and diagnosis of obstetric pathology in the bitches

The article presents the results of ultrasound examination of uterine females in the postpartum period. It is established that during its physiological course on the 3rd day, the cervix and body of the uterus are placed in the pelvic cavity dorsally with respect to the bladder, and the horns of the uterus - in the abdominal cavity cranially, in the area of - the loops of the large intestine. On the ultrasound it is noted that the horns of the uterus are expanded, with a diameter of 15-18 mm. The walls of the horns are thickened, with sections from 4 mm to 6 mm. Its tissues are of average echogenicity, of heterogeneous consistency. Hypoechoic homogeneous content is observed in the visualized uterine cavity. In females with delayed litter during this period, uterine horns with a diameter of 1.91–1.96 cm were visualized, with a thickened wall that had hypoechoic areas. In addition, the endometrial relief was folded, uneven, and in some places, its desquamated fragments were visualized. Diagnostic sign of delay of litter was the detection in the uterine cavity of tissue structures of amniotic membranes with increased echogenicity. On the 7th day after childbirth, ultrasound signs of metritis were detected on the background of the delay of the litter. The uterine wall reached 3.3–3.9 cm, had a heterogeneous tissue structure and increased echogenicity. In the internal relief of the uterus, areas of desquamated endometrium were visualized and hyperechogenic contents were present in the uterine cavity. It is proved that ultrasound scan of the uterus into the bough is an eff ective method of monitoring the course of postpartum involution and provides early diagnosis of obstetric pathology. The main diagnostic ultrasound indicator for the delay of litter in the boughs is the visualization of the structures of the amniotic membranes in the uterine cavity, hyperechogenic areas and thickening of its walls. The development of postpartum metritis is indicated by signifi cant thickening of the uterus and its mucous membrane, areas of desquamated endometrium and the presence of hyperechoic content in the uterine cavity. Key words: bitch, postpartum period, uterine involution, delay of litter, metritis, ultrasound.

Perbandingan Efektifitas Mobilisasi Dini dan Senam Nifas Terhadap Involusi Uterus pada Ibu Postpartum Normal di Bidan Praktek Mandiri (BPM) Kota PematangSiantar

Failure of the uterus to contract after childbearing is one in all the causes of maternal death. Numerous makes an attempts were created to enhanced the power of the uterus to contract. The aim of the study was to compare the effectiveness of postpartum exercise with early mobilization of uterine involution in normal postpartum. This type of research was a quasi-experimental design with a pretest and posttest design group. This research was implemented in midwives practicing independently. The population of this study was all normal postpartum. The sample of the study was 34 normal postpartum, aged 20-35 years, 2-4 parity, baby born healthy, postpartum haemoglobin ≥ 10.5 gr%, exclusively breastfeeding. Early mobilization was carried out after two hours postpartum and postpartum exercise was carried out for six days. Measurement of the postpartum fundal height was performed on days 1st, 3rd and 7th using a caliper pelvimeter. Consecutive sampling was used in this study. The difference between the two groups was analyzed by unpaired t-test and Mann Whitney U-test. There was a difference in the height of the uterine fundus on the third and seventh postpartum days between the two groups. Postpartum exercise was more effective than early mobilization in accelerating uterine involution. Therefore, it is expected that midwives can facilitate mothers to do postpartum exercise from the first day of postpartum. Keywords: postpartum exercise; early mobilization; postpartum; involution; uterus ABSTRAK Salah satu proses penting pada masa nifas adalah pemulihan organ reproduksi yang ditandai dengan penurunan tinggi fundus uteri dan derajat kontraksi uterus. Secara bertahap, uterus yang berkontraksi dengan baik akan berkurang ukurannya sampai tidak dapat dipalpasi lagi di atas simfisis pubis. Diantara faktor yang berperan dalam kontraksi uterus adalah mobilisasi dini dan senam nifas. Tujuan penelitian adalah untuk membandingkan efektifitas mobilisasi dini dan senam nifas terhadap involusi uterus pada ibu postpartum normal. Jenis penelitian adalah desain kuasi eksperimental dengan kelompok pre dan posttest. Responden penelitian adalah 34 orang ibu postpartum, usia 20-35 tahun di Bidan Praktek Mandiri Kota Pematangsiantar, Juni-September 2016. Teknik pengambilan sampel adalah consecutive sampling sesuai dengan kriteria inklusi. Dilakukan senam nifas pada kelompok intervensi dan mobilisasi dini pada kelompok kontrol. Pengukuran tinggi fundus uteri dilakukan sebelum dan setelah perlakuan pada hari ke-1, -3 dan -7. Analisa data menggunakan uji t-tak berpasanagn dan Mann Whitney menggunakan SPSS versi 20.0. Terdapat perbedaan tinggi fundus uteri hari ke-3 dan ke-7 antara senam nifas dan mobilisasi dini. Senam nifas lebih efektif menurunkan tinggi fundus uteri dibandingkan mobilisasi dini. Bidan diharapkan dapat memfasilitasi ibu melakukan senam nifas sejak hari pertama postpartum. Kata kunci: senam nifas; mobilisasi dini; postpartum; involusi; uterus