Van Schoubroeck D, Van den Bosch T, Scharpe K, Lu C, Van Huffel S, Timmerman D
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Belgium.
Ultrasound Obstet Gynecol. 2004 Apr;23(4):378-81. doi: 10.1002/uog.963.
Heavy bleeding in the late postpartum has, in some cases, been attributed to subinvolution of the placental bed and enhanced myometrial vascularity (EMV) as seen on color Doppler imaging. The aim of this study was to investigate the incidence and spontaneous evolution of areas of enhanced vascularization over the whole thickness of the myometrium in asymptomatic women after uncomplicated term pregnancy.
This was a prospective descriptive study involving 93 consecutive women who were examined on day 3 (mean 2.6 +/- 1.5) and at 6 weeks (mean 6.5 +/- 1.3) after delivery following an uncomplicated term pregnancy. EMV was defined as the presence of marked flow over the full thickness of the myometrium reaching the uterine cavity. Doppler flow examination within the area of EMV and of both uterine arteries was performed.
The mean patient age was 29.1 years and average parity was 1.7. The mean gestational age at delivery was 39.1 weeks. Areas of EMV were visualized in 50.5% of patients on day 3 vs. 3.9% at 6 weeks. None of the patients required therapy for bleeding problems. The mean pulsatility index and peak systolic velocity in the area of EMV on day 3 were 0.45 +/- 0.30 and 0.37 +/- 0.20 m/s, respectively. A consistent increase in vascular resistance and decrease in blood flow velocity was observed in both uterine arteries between day 3 and week 6.
Most areas of EMV reflect intermediate stages in the involution of the placental bed and do not cause abnormal postpartum bleeding. EVM is common in the puerperium, disappears spontaneously in the vast majority of cases, and does not warrant treatment if asymptomatic. Further research is needed to predict the rare cases in which subinvolution of the placental bed leads to heavy bleeding in the late postpartum.
产后晚期的严重出血在某些情况下归因于胎盘床复旧不全以及彩色多普勒成像显示的子宫肌层血管增多（EMV）。本研究的目的是调查无并发症足月妊娠后无症状女性子宫肌层全层血管增多区域的发生率及自然演变情况。
这是一项前瞻性描述性研究，纳入了93例连续的女性，她们在无并发症足月妊娠分娩后的第3天（平均2.6±1.5天）和第6周（平均6.5±1.3周）接受检查。EMV定义为子宫肌层全层出现延伸至子宫腔的明显血流。对EMV区域及双侧子宫动脉进行多普勒血流检查。
患者平均年龄为29.1岁，平均产次为1.7。平均分娩孕周为39.1周。第3天50.5%的患者可见EMV区域，而第6周时为3.9%。所有患者均未因出血问题接受治疗。第3天EMV区域的平均搏动指数和收缩期峰值流速分别为0.45±0.30和0.37±0.20m/s。第3天至第6周期间，双侧子宫动脉的血管阻力持续增加，血流速度降低。
大多数EMV区域反映胎盘床复旧的中间阶段，不会导致产后异常出血。EVM在产褥期常见，绝大多数情况下会自发消失，无症状时无需治疗。需要进一步研究以预测胎盘床复旧不全导致产后晚期严重出血的罕见病例。
